ANNAPOLIS – Managed care for the poor in Garrett County may be in jeopardy next year, health professionals warned legislators this week.
No one in Maryland’s Department of Health and Mental Hygiene can say for sure whether HealthChoice, the state’s 5-year-old managed Medicaid program, will be able to continue in Garrett now that one of two insurance groups is freezing enrollment. Maryland’s westernmost county could be the first in the state to be dropped from the program.
To participate in HealthChoice, a Maryland jurisdiction must offer a choice between at least two insurance groups to cover their medical care.
Otherwise, the state is left to cover Medicaid patients on a “fee-for- service” system, in which the state reimburses doctors directly for the care they give Medicaid clients.
Fee-for-service doesn’t guarantee a patient will be able to keep a certain doctor, nor does it provide the educational and preventive services managed care does to keep people healthy.
Two HealthChoice managed care groups serve Garrett County Medicaid clients: Priority Partners, managed through Johns Hopkins University, and Maryland Physicians Care.
Priority Partners covers roughly a quarter of the HealthChoice members in Maryland; MPC covers about a fifth.
But Priority Partners announced earlier this year it will freeze its HealthChoice enrollment statewide in 2002, a move that could kill the program in Garrett County if the health department can’t offer residents another insurance group choice.
Priority Partners Chief Executive Officer Cynthia Demarest was not available for comment.
Health department officials caution they’re not sure what the enrollment freeze will mean to county Medicaid recipients.
“There are options we’re looking at now,” said Susan Tucker, executive director of the Office of Health Services. “We might be able to get Priority Partners to not freeze (enrollment) in Garrett County, or there might be other MCOs willing to move in.”
The managed care companies will give the health department their 2002 plans next week, Maryland Physicians Care Vice President Don Blanchon said.
Nearly 16 percent of adults and about a quarter of the children in Garrett County live below the poverty level. Of the 5,900 people enrolled in Medicaid in the county, 4,114 – 13.7 percent of the county’s residents – are HealthChoice members.
Providers and insurers brought up the Garrett County situation at a HealthChoice briefing before the House Economic Matters Committee Wednesday as an example of how serious the program’s funding problem has become. Both providers and managed care groups have been losing money on the program since its inception in 1997.
On the Eastern Shore, specialists have virtually abandoned HealthChoice because of funding, a problem that may be exacerbated by the revelation Tuesday that the Medicaid program faces a $457 million deficit in the next two years.
Delegate Michael R. Busch, R-Anne Arundel, committee chairman, said he wants to see managed care kept alive in Garrett.
“I would hope everyone in Garrett County . . . would be able to stay in the MCO systems,” Busch said after the briefing. “I’d hope the governor and the General Assembly would be able to find the necessary funding to do it.”