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August Miller, KSL, File

Utahns with Medicaid, CHIP through Molina to lose coverage in U. health system

By Ben Lockhart, KSL  |  Posted May 23rd, 2018 @ 2:04pm


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SALT LAKE CITY — Beginning Sept. 1, Utahns who get their Medicaid coverage through Molina Healthcare will no longer be insured for nonemergency services they receive through the University of Utah Health system, with few exceptions.

Medicare recipients who are enrolled through Molina Medicare Options Plus will also lose their coverage for services provided by the academic hospital and clinic system. However, that change will not affect those who get coverage through Molina's Health Advantage or Healthy Advantage Plus plans.

Enrollees in the Children's Health Insurance Program will likewise lose coverage for services, though they and the others affected will be able to "continue to (be insured) for pediatric subspecialty services," said Richard Dow, director of managed care contracting for University of Utah Health.

Dow cited recent "significant administrative issues with Molina that have not been fully resolved" as the reason for ending University of Utah Health's relationship with some of the carrier's programs. Despite renegotiating its contract with Molina in 2016 to address those concerns, he said, "the operational challenges continued."

"Essentially, they weren't loading our providers appropriately in their claims systems," Dow said. "We had significant claims denials and slow claims processing turnaround times to the point that we have significant financial issues with Molina claims."

Asked for a response to University of Utah Health's decision and its reasoning behind it, Molina issued a statement saying it was "deeply disappointed" but busy making other arrangements for its enrollees.

"Although we are deeply disappointed with the University of Utah’s decision to end our relationship for those lines of business, our members can continue to receive high-quality care from one of our many in-network provider partners across the state, which includes 37 hospitals," among them Primary Children's Hospital, St. Mark's Hospital and Jordan Valley Medical Center, the statement said.

"Our top priority during this time is to ensure that our members do not experience a disruption in care, which is why we have teams in place to help members experience a smooth transition to other in-network providers."

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Without its University of Utah Health contract, Molina does "certainly have other contracted (provider) networks that are able to provide services," said Kolbi Young, a spokeswoman for the Utah Department of Health specializing in Medicaid and CHIP.

Still, the Department of Health "will be reviewing the Molina network … to ensure that it is still adequate to provide services to enrolled Molina members," Young said.

As of last week, there were more than 71,000 Medicaid recipients and more than 7,700 CHIP recipients in Utah enrolled through Molina, according to the state Department of Health. It wasn't clear Tuesday how many Utahns are enrolled in Molina for Medicare, a program run solely by the federal government.

University of Utah Health issued letters late last month notifying all of its patients who could be affected, according to Dow.

A Medicaid open enrollment period in Utah, which opened last week and runs through June 15, allows recipients to sign up for the carrier and plan through which they receive their benefits.

Dow said Medicaid recipients who want to continue using services from University of Utah Health would be able to keep their coverage there by switching to other plans already "required to offer similar benefit structures" as the one being affected.

"If they switch … it should be seamless for both provider and for the patient," Dow said. "We're hoping to continue to maintain those relationships with our great patients going forward."

Young echoed Dow's comments, saying in an email that the only difference between carriers in terms of Medicaid coverage is the specifics of the provider network they offer.

"When an applicant is approved for Medicaid or CHIP, depending on where they live, they can select a health plan. The benefit package and covered services are the same among the plans. The only difference is the provider network," Young said in an email.

Young said that under the state's guidance, and with the cooperation of University of Utah Health and Molina, Medicaid and CHIP recipients who are affected will be "allowed to switch health plans in order to ensure access to care."

Young said she couldn't speak to the changes affecting recipients of Medicare, since the state doesn't help the federal government operate that program.

Young advised anyone with questions about how they might be affected or what to do can direct their questions to the Department of Health at 1-866-608-9422.

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