One of organizations that helps manage BadgerCare Plus is hinting it may leave the partnership and join with another company, jeopardizing the coverage of thousands of Wisconsinites.
In an email to The Badger Herald, Molina Healthcare of Wisconsin, one of the four health maintenance organizations in BadgerCare Plus in southeastern Wisconsin, said it remains committed to the state of Wisconsin and providing care to its members as long as it can receive sound rates.
“We continue to work closely with [the Centers for Medicare & Medicaid Services] and with the state to achieve actuarially sound rates,” Molina said. “If we are unable to achieve rates that are actuarially sound, it may no longer be feasible for us to continue as a health plan in the state.”
The company also said in the email that all HMOs are required by the state contract to provide services for at least 90 days after they notify the state of terminating their contract. They said this allows time for a smooth transition.
According to its second quarter earnings report, Molina Healthcare provides 42,000 Wisconsinites with coverage.
Bobby Peterson, executive director of the nonprofit public interest law firm ABC for Health, said while the state cut funding for BadgerCare Plus, part of the reason behind Molina’s statement is because of contract negotiations. He said the companies, such as Molina, are playing hardball with the state for better payments.
Peterson said UnitedHealthcare, one of the other four companies with a contract with the state for BadgerCare Plus, decided to drop its contract Nov. 1 after they claimed they were losing money in payments.
“The state is [playing] a game of chicken,” Peterson said. “UnitedHealthcare is walking away after calling the bluff.”
UnitedHealthcare declined to comment for this story.
Peterson said UnitedHealthcare provides for 174,000 people, and the state contract pays for the HMOs based on the number of people enrolled in each program, not on how many times they make a visit to the doctor.
Peterson said the companies are alleging the state has not been paying enough to help them generate a profit. However, he said it would depend on an outside auditor to really assess the situation and investigate whether the problem is with the amount of money the state is paying or whether the company has internal problems.
For instance, Peterson said the companies may not be efficiently managing its resources or may not have its members in programs to prevent long-term health problems.
Peterson said the idea behind the BadgerCare Plus program is to create incentives so companies can take care of people early, help manage the health care of the recipients of coverage and prevent them from having to go to the hospital in the first place.
He added UnitedHealthcare’s drop of 174,000 members of will mean the state will revert back to its old model – money goes directly to the doctors when people visit the hospital. The state would also be paying doctors less than the doctors would receive from the HMOs, he said.
“[There’s] no bigger picture of helping people live better lives, but just paying for the services,” Peterson said.
The Wisconsin Department of Health Services and the two other HMOs who make up BadgerCare Plus in the south east part of the state, Children’s Community Health Plan and CommunityConnect HealthPlan, did not return requests for comment.