N.H. Still Hashing Out New Medicaid Contract

Valley News Staff Writer
Published: 4/27/2016 9:24:05 AM
Modified: 8/14/2015 12:00:00 AM
Concord — A two-year, $1.6 billion contract will keep alive a fledgling system in which private companies administer New Hampshire’s health insurance program for low-income people but a dispute between those companies and mental health care providers remains unresolved.

The stand-off between the state’s 10 community mental health centers and the two insurance companies that now hand out Medicaid payments could undermine recent reforms, state Health and Human Services Commission Nick Toumpas on Thursday warned a commission overseeing a Medicaid makeover that was mandated by a 2011 law and began 21 months ago.

“Without the ability to provide mental health services, the entire program would unravel,” he said.

As of Aug. 1, about 162,000 Medicaid recipients collected their Medicaid benefits from two insurance companies: about 88,000 from Well Sense, a unit of Boston Medical Center Health Plan Inc., and 74,000 from New Hampshire Healthy Families, a unit of Centene Corp., a St. Louis-based insurance company with annual revenue of $16.6 billion.

On Aug. 5, the state Executive Council approved a deal that will keep Well Sense and NHHF managing care in New Hampshire Medicaid until June 2017. The deal also cleared the way for a new phase of the program in which the state plans to move to managed care another 10,000 Medicaid recipients, including those with developmental disabilities, nursing home residents and patients who receive similar care at home.

Some at the meeting seemed less than eager to get on the reform bandwagon.

“Managed care is really not value-added for our residents,” said Ted Purdy, administrator of the Sullivan County Health Center, a county owned and operated, 156-bed nursing home. “We are very highly regulated,” and there are extensive quality of care measures in place, he added.

By comparison, mental health care providers seemed anxious to get on the bandwagon but unhappy at the terms they were being offered. In July, two officials of the organization of the state’s community mental health centers wrote a letter that accused Well Sense of seeking rate cuts as large as 30 percent that would “crush an already fragile system and reduce clinical availability across our state.”

The exact numbers remained fuzzy. On Thursday, Suellen Griffin, the executive director of West Central Behavioral Health in Lebanon and chairwoman of the statewide organization, said she was unsure about the size of the proposed cuts and Toumpas declined to provide a figure, although he did say that “the absolute number of dollars going into mental health (services) did not go down.”

Still, the proposed cuts are seen as threats by clinic operators, and a pending rupture between providers and care managers was avoided only when the two sides agreed to a makeshift arrangement in which some costs, such as case management and administration, will be compensated on a per patient per month basis but general care will be paid for on a fee-for-service basis. That pay-as-you-go basis, traditionally used in mental health and other medical care, has become a target for reformers.

Griffin characterized the makeshift plan as “a great step backward for the mental health system .”

Noting that neither of the two managed care companies had more than seven months experience with a new system in which mental health care providers received per patient, per month payments, Griffin said clinic operators were “really disappointed we had (so little time) to get the bugs out” of the new arrangement.

At least a half dozen representatives of the managed care companies attended the meeting but none spoke. After the meeting, Lisabritt Solsky of Well Sense said that her company is “eager to get back to the table” to work out a new deal with mental health care providers. Jay Gonzalez, chief executive of NHHF, said he had no comment.

Rick Jurgens can be reached at rjurgens@vnews.com or 603-727-3229.

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