Two Illinois Medicaid managed-care insurers become one
And then there were six … again.
The state's overhauled Medicaid managed care program is back down to six following the consolidation of two health plans.
Harmony Health Plan is becoming part of Meridian Health Plan following WellCare's $2.5 billion acquisition of Meridian. Harmony members will automatically be enrolled with Meridian on Jan. 1, unless they request otherwise.
The consolidation came at a good time for Harmony. In a May letter to the health plan, the state said it would no longer automatically enroll members in the plan since Harmony didn't have enough doctors and hospitals in its network to ensure adequate access.
"During this time, we are committed to providing a seamless transition for our members, providers and state partners, WellCare said in a statement. "As a result of these changes, our provider partners will be able to operate with one combined plan, which will grant broader network access to our members in Illinois."
WellCare did not respond when asked what will happen to the sanctions against Harmony now that it's being absorbed by Meridian.
The Illinois Department of Healthcare and Family Services oversees HealthChoice Illinois, the state's nearly one-year-old Medicaid managed care program, in which private insurers administer Medicaid benefits.
Meanwhile, the state has eased sanctions against another participating insurer, Blue Cross and Blue Shield of Illinois. As of last month, Medicaid enrollees can once again select plans from the largest insurer in the state.
Blue Cross was placed on an enrollment hold in April for not having enough doctors and hospitals in its network to ensure adequate access for members in certain areas, and failing to address a backlog of grievances and appeals from members.
Despite demonstrating "changes the health plan has made to come into compliance," Blue Cross remains on a corrective action plan and members will not be automatically enrolled, according to letter Healthcare and Family Services sent the insurer on Oct. 19.
A follow-up audit and file review is scheduled to take place next month. If Blue Cross does not show "necessary improvement," the department can reinstate the full enrollment hold and impose a performance penalty starting at $50,000, the letter states.
Blue Cross did not respond to a request for comment.
As of Sept. 1, Blue Cross had enrolled about 416,000 people, which is 19% of total HealthChoice Illinois enrollment, state data shows. Meridan leads the board with about 609,000 people or 27% of total enrollment—not including Harmony's nearly 247,000 enrollees.
It hasn't been unusual to see fines since the program launched. Blue Cross, Molina Healthcare of Illinois and NextLevel Health, the latest insurer to join the program, have all been fined at least $100,000 for failing to submit complete and comprehensive encounter data, or records of covered health care services.
As Healthcare and Family Services employees have today off work for Election Day, the department did not immediately respond to a request for comment.
"Two Illinois Medicaid managed care insurers become one" originally appeared in Crain's Chicago Business.
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