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Blues to keep covering Medicaid enrollees in Rochester area

Rochester Business Journal
November 7, 2013

Excellus BlueCross BlueShield now plans to keep covering some Medicaid patients, including enrollees in Rochester-area counties, company officials said Thursday.

Excellus offers managed care Medicaid plans across much of Upstate New York using the Monroe Plan for Medical Care, an independent Rochester-based physician organization, as its Medicaid network.

But citing its expectation of losses of some $100 million on Medicaid this year, the insurer had announced plans to pull out of the Medicaid market in 25 counties as of January.

Excellus said Thursday it will continue to offer Medicaid coverage in 11 of the counties it had planned to drop: Monroe, Livingston, Ontario, Orleans and Wayne, along with Broome, Herkimer, Oneida, Otsego, Seneca and Yates counties.

Deals struck with the Rochester area’s three major health systems and tightening of Excellus’ internal controls will let the insurer cut but not eliminate its Medicaid losses. Losses in remaining counties in central and northern New York still will be unsustainable, said James Redmond, Excellus vice president of communications.

The insurer will continue to offer Child Health Plus and Medicare plans across its coverage area, he added.
 
The 25-county Medicaid pullout would have affected 196,000 Medicaid enrollees, including roughly 73,000 in Monroe County and another 35,000 in adjoining counties. Some 100,000 now will retain coverage, Redmond added.

State officials said in October they were in talks with other insurers interested in picking up Medicaid in 20 of the 25 counties Excellus planned to abandon.

Not clear, however, was whether doctors would be willing to join other insurers’ networks.

Some physicians would not accept insurance from other plans with lower provider reimbursement rates, Monroe County Medical Society executive director Nancy Adams told the Rochester Business Journal in a recent interview.

The new deal will ensure broad access to physicians for Medicaid patients, Adams said Thursday.

“In classic Rochester fashion, major stakeholders agreed to work together and help address an important issue for the good of the people who live in this region,” Excellus CEO Christopher Booth said in a statement. “I’m very grateful to each of the hospitals and the Monroe Plan for stepping up to help preserve this program.”  

(c) 2013 Rochester Business Journal. To obtain permission to reprint this article, call 585-546-8303 or e-mail service@rbj.net.
 


 


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