Editor's Column - September 2015

Tim BenjaminAs I write this, we’re still enjoying the last days of summer, but warm weather is just about over. While the kids are back in school, they’re also still romping on the playground in t-shirts and shorts. Many of them are probably looking forward to cold and winter sports. But those of us using wheelchairs are not as eager for the snow or the cold. The long-term prediction for the winter is a couple degrees above average. That’s good news, I guess, but a couple degrees is not enough to keep me warm—how about you?

By now you’ve heard that UCare is not in the group of HMOs and insurance providers approved to insure individuals through the State of Minnesota’s Prepaid Medical Assistance Program and MinnesotaCare. In other words, the state’s largest health care plan, serving 369,000 individuals in two state-funded public programs, will not be able to serve its enrollees. If you are enrolled in either of these programs, you should probably contact UCare to find out your best course of action. Don’t wait too long; UCare will be excluded from participating in Minnesota’s medical assistance programs beginning in January 2016. That is, unless they are successful in a lawsuit they have filed to determine whether the state’s bidding process was conducted fairly.

On September 4, a judge rejected UCare’s bid for an injunction to delay the start of 2016 enrollment in medical assistance and MinnesotaCare. But the judge did expedite the date for a trial, and that will take place November 2. In the meantime, DHS’s enrollment process for 2016 has begun. Scott Ikeda, assistant attorney general for the State of Minnesota, suggested that UCare is trying to roll back the clock to a time before the legislature required competitive bidding. DHS assistant commissioner Nathan Moracco said that UCare lost the 2016 contract simply because they didn’t score high enough on cost and quality measures compared to the competition.

All of this is creating a lot of confusion for UCare clients and will probably result in many people losing their jobs at UCare because of the loss of this huge contract. Some estimates are that about half of UCare’s $3 billion in revenue in 2014 came from Minnesota public insurance programs. There may be an impact as well on many independent durable medical
supplies providers that UCare clients used. But of greatest concern is the probable damage to the trusted and confidential relationships between thousands of patients and their doctors and other healthcare providers who may not be in their new networks.

The most challenged of Minnesota’s citizens are being expected to make significant choices about the source of their healthcare services in a short period of time. There will be fewer healthcare insurers to choose from for 2016-2017, and the Department of Human Services says that it expects to save $450 million in the next two years. Cutting out choices for citizens may reduce costs in the short run but future costs could skyrocket. As just one example, if a person with a disability doesn’t have confidence in a new doctor or is reluctant to go to a new hospital,
there could be delayed interventions and more emergency room visits, at much higher cost.

As far back as I can remember, UCare has been at the top of Minnesota insurance providers as an innovative, ethical and patient-centered organization, and has always been an insurer for those on medical assistance. UCare’s popularity is obvious, with its hundreds of thousands of enrollees. What’s more, Minnesota counties determine which of the state’s recommended providers to make available to their citizens. Out of 87 counties, 55 recommend UCare as one of the insurance providers. UCare’s lawsuit will seek to continue to provide service in those counties. Stay tuned until early November, and meanwhile, contact UCare and DHS with your questions.

Speaking of early November, don’t forget the Charlie Smith award banquet. Sounds like a long time away, but November 6 is just around the corner. Come and celebrate this year’s winner, Jessalyn Akerman-Frank, with us, and until then, enjoy the beautiful days of early fall. We’ll keep talking, here in print, and at accesspress.org, about other news in our community. Stay safe!

 

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