Dartmouth signs onto NH Medicaid managed care

CONCORD, N.H. (AP) -- New Hampshire's largest health care provider signed contracts Monday with three health care plans to join the state's managed care network for Medicaid — a key to getting the network operating.

Dartmouth-Hitchcock announced it will work with Well Sense Health Plan, Granite State Health Plan and Meridian Health Plan of New Hampshire to provide coordinated care for eligible Medicaid beneficiaries. Dartmouth-Hitchcock said that by signing with all three managed care plans, Medicaid recipients would have access to Dartmouth-Hitchcock providers regardless which plan they choose.

"By taking this action today, we are acting in the best interests of New Hampshire and the people we are privileged to serve. To create a truly sustainable health system, all New Hampshire residents need access to high-quality, coordinated health care when and where it's needed, with value-based approaches that keep our population healthy and out of the hospital," Dartmouth-Hitchcock CEO and President Dr. James N. Weinstein said in a statement.

The state has been trying to move from a fee-for-service health model to managed care for its Medicaid clients but needed participation from hospitals to make it work. New Hampshire's Medicaid program covers low-income children, parents with nondisabled children under 18, pregnant women, senior citizens and people with disabilities.

The budget that was adopted two years ago, written by Republicans, cut state hospital aid for all but a handful of critical access hospitals. Hospitals, mental health clinics and other providers refused to participate in the managed care system because of low reimbursement levels for treating Medicaid patients. The 10 largest hospitals also sued over Medicaid rates, which complicated efforts to negotiate over managed care.

The new budget restores some of the aid, but requires hospitals to agree in writing to participate in the managed care network by July 1 with a final agreement by Aug. 1 to receive the aid. New Hampshire's Department of Health and Human Services also changed key rates to entice providers — especially hospitals — to participate in managed care.

Under the managed care program, the state will pay the three insurance plans a set amount to care for Medicaid clients. Medicaid clients will be asked to select a plan this fall, according to Dartmouth-Hitchcock. The state will assign people who fail to choose a plan to one. Dartmouth-Hitchcock said providers initially will be reimbursed under a fee-for-service payment model which may include incentives for improving the quality of care delivered to patients.

An 11-member commission appointed this year by Gov. Maggie Hassan will monitor the program.

Meanwhile, the state budget also requires a nine-member commission to begin meeting this month to study the impact and possible alternatives to expanding Medicaid under the federal health care overhaul. Hassan and the Democratic-led House wanted to authorize expansion Jan. 1 in the new state budget, but the Republican-led Senate insisted on considering the impact on New Hampshire first.

The compromise was to establish the commission which is to issue its report Oct. 15. Hassan has said a special legislative session may be needed to authorize Medicaid expansion to begin capturing the estimated $2.5 billion in federal funding the state would get over seven years.

The expansion would add anyone under age 65 who earns up to 138 percent of federal poverty guidelines, which is about $15,000 for a single adult.

New Hampshire could refuse or postpone a decision, but there are benefits for states that choose to expand Medicaid now. The U.S. government will pick up the entire cost in the first three years and 90 percent over the long haul. Hassan said delaying expansion could cost New Hampshire up to $340 million next year.

State officials said the three managed care operators had counted on Medicaid being expanded to cover an estimated 58,000 adults when they contracted with the state. That was before the U.S. Supreme Court ruled expansion was optional.