Friday, March 26, 1999
HMO for low-income loses license
21,000 clients now must find new plan
BY TIM BONFIELD
The Cincinnati Enquirer
More than 12,000 low-income Hamilton County residents will have to make new health plan arrangements within weeks because the state has revoked the license of their Medicaid HMO, Health Power HMO Inc.
The revocation, issued March 18 by the Ohio Department of Insurance, technically takes effect May 1. But 12,428 Health Power enrollees in Hamilton County and another 8,553 in Franklin County will have to switch to other plans or back to traditional Medicaid by April 1.
The Health Power collapse, which came after months of failing to meet state fiscal solvency rules, creates several hassles for customers. It also marks the end, at least temporarily, of a managed care experiment in Hamilton County that required Medicaid recipients to join an HMO.
“This was supposed to be a demonstration project. I guess it demonstrated that some of the HMOs couldn't make it. The state needs to make sure it is providing a reasonable rate of payment,” said Randall Garland, executive director of the Cincinnati Health Network, a clinic system that cares for large numbers of Medicaid patients.
The biggest hassle facing enrollees is deciding whether to join the sole remaining Medicaid HMO in town — Cincinnati Area Health Plan — or returning to traditional Medicaid. The HMO may not include all the doctors who participated in Health Power. On the other hand, no doctor is required to accept a traditional Medicaid card.
“Finding doctors (who would accept Medicaid) was a problem before the HMOs started. It may be a bigger problem now,” Mr. Garland said.
In addition, pharmacy services will be confused for the next week or so. That's because the company that was subcontracting pharmacy benefits for Health Power decided to pull out effective today rather than wait until month's end. Health Power has pledged to make alternative arrangements.
After starting in Montgomery County, the mandated Medicaid managed care program came to Hamilton County in 1995 as a way to combat escalating Medicaid expenses.
At first, enrollees could choose from six HMOs. By early 1998, it was down to three. Now, there's only one left, which means the state cannot require people to join an HMO.
Cynthia Burnell, Ohio's Medicaid managed care bureau chief, said she expects few disruptions for enrollees because most Health Power doctors accept traditional Medicaid. The state also hopes to bring another Medicaid HMO to town, so the program can return to its mandatory status.
As for whether the state's payment rates to Medicaid HMOs are high enough, Ms. Burnell said, “We have other managed care plans that seem to be able to provide services at our rates.”
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