State officials insist two of the three insurance companies participating in the Husky program—that had to suspend enrollment in their medical plans earlier this month because they didn’t have enough doctors participating in their networks—are now ready to start enrolling new patients.
This Dec. 5 letter from the federal Centers for Medicare and Medicaid Services had asked the state Department of Social Services to cease enrollment of its Husky clients in Aetna Better Health and AmeriChoice, until those insurance companies had an “adequate” number of doctors and hospitals participating in the plan.
“A letter was prepared to inform Aetna and AmeriChoice members that neither plan currently met the department’s network adequacy requirements in the specific identified counties, and to give members opportunity to change plans. The letter was scheduled for mailing today; however, it was pulled back as both Aetna and AmeriChoice concluded agreements with hospitals in these counties, as noted above,” Michael Starkowski, Social Services Commissioner, wrote in this letter Tuesday to federal officials.
Now all three insurance companies have a contract with at least one hospital in at least one county of the state, Starkowski pointed out in his letter. In addition, the Federally Qualified Health Centers have concluded an agreement with the state to participate with all of the health plans at each of their locations and there have been dramatic improvements in the physician networks, including agreements between Aetna and AmeriChoice with the Yale Physicians Group.
Will this be good enough for health care advocates looking out for the vulnerable Husky population?
Probably not based on Sheldon Toubman’s letter Tuesday to the Centers for Medicare and Medicaid Services.
In this letter, Toubman asks CMS to deny the state’s application requesting permission to ask 138,000 Husky patients to voluntarily transition out of Anthem and into one of the three insurance companies.
“DSS provides no explanation justifying its use of antiquated cookbook ratios for primary care providers,” Toubman said.
An independent survey conducted by a Yale University student concluded that the medical provider networks for Aetna and AmeriChoice are “significantly less robust than is reported by these companies, based on their online provider lists.”
For example in New Haven county only one-third of pediatricians listed as accepting Aetna report that they are not accepting new patients under the plan and of those listed as accepting AmeriChoice, one-tenth of the pediatricians are accepting no new patients, while nearly a quarter are either not accepting any new patients with the plan or will only see new patients who meet particular age or residence requirements. The same was mostly true of Hartford county pediatricians.
“These concerns are not merely hypothetical. Of the approximately 28,000 HUSKY enrollees who already moved to Aetna and AmeriChoice as a result of DSS’s ill-timed letters, many are being confronted with provider access problems already, with the new plans’ listed providers, for both primary and specialty care, proving to be unavailable to them,” Toubman wrote. “Since the adequacy of the networks has not been established, the remedial conditions set forth in your December 5th letter, which DSS has accepted, should also now be implemented without delay.”
Federal officials are expected to weigh in on this matter in the next week.