Pa. Medicaid expansion plans struggle to sign up providers

Medicaid managed-care plans providing coverage under Pennsylvania's Medicaid expansion are struggling to find enough hospitals and physicians for their networks.

Insurers say the problem arises from false expectations set by the administration of Gov. Tom Corbett and the state Department of Public Welfare that the plans would pay providers more than traditionally low Medicaid rates.

“The problem is, it's not funded as a commercial-type offering,” said Patricia Darnley, CEO of Gateway Health. Gateway is one of nine plans chosen for the Healthy Pennsylvania demonstration program to expand Medicaid to as many as 500,000 adults in the state with incomes between 100% and 138% of the federal poverty level. Providers “are looking for commercial funding, and in our state commercial funding is nowhere near Medicaid funding,” she said.

Dennis Olmstead, chief strategy officer for the Pennsylvania Medical Society, said doctors also are balking because of the rate issue. “Absolutely, some may decline being part of the networks if they are given a choice, while others may feel it's their moral duty to serve these individuals,” he said. But he added that some doctors may not be able to decline because they have “all-product” clauses in their contracts with insurers, requiring them to serve members of all plans offered by that insurer, including a Healthy Pennsylvania plan.

The Medicaid plans have until Oct. 17 to receive state certification confirming they have enough providers to offer adequate access to the expanded Medicaid-eligible population. Enrollment is scheduled to begin Dec. 1.

Follow Virgil Dickson on Twitter: @MHVDickson