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More than 1,200 county residents to face change in managed-care provider

December 03, 2012|By KAUSTUV BASU | kaustuv.basu@herald-mail.com

WASHINGTON COUNTY — More than 1,200 Washington County residents who receive free or subsidized outpatient health care will have to choose a new managed-care organization or be automatically switched to one to receive benefits after Dec. 31, 2012.

Maryland’s Primary Adult Care Program, or PAC, enables residents with low incomes who are not on Medicare and not eligible for full Medicaid benefits to get free or subsidized outpatient health care.

In Washington County, about 2,150 residents are enrolled in the care program, which began in July 2006.

But come Jan. 1, about 1,280 of those individuals will get their benefits through a different managed-care organization. These patients will have to choose a new provider by a Dec. 21 deadline or be automatically switched to one.

That’s because Maryland Physicians Care, a managed-care organization through which residents could enroll for the program, no longer will provide coverage.

County residents will be enrolled through two other health care organizations: Amerigroup or United Healthcare. The state’s health department is asking patients to check with their doctors to find out which managed-care organizations they will accept.

Maryland Physicians Care is co-owned by Washington County-based Meritus Health. The other owners are Maryland General Health Systems, St. Agnes HealthCare and Western Maryland Health Systems.

Statewide, 63,000 people participate in the program, 12,400 of whom will need to switch providers.

Cynthia Demarest, chief executive officer of Maryland Physicians Care, said the company decided not to participate in the program because it was experiencing losses.

“Given the financial performance of the PAC program in CY (calendar year) 2011, 2012 and projected CY 2013, the program is not financially viable for MPC,” she said in an email.

The state expanded the benefits available through the PAC program in 2010 to include emergency hospital visits and substance-abuse programs, leading to the losses, Demarest said.

She said Maryland Physicians Care explored various options to remain part of the program, but the state’s Department of Health and Mental Hygiene “would not accept the options presented.”

Charles Milligan, a deputy secretary at the state health department, stressed there won’t be any disruptions to the program.

“We will be working with the individuals to help select new plans. I think the process will be seamless for the vast majority of people,” he said.

Jodie Ostoich, executive director at REACH of Washington County, a nonprofit organization that helps disadvantaged individuals, said any change in the PAC program might have unintended consequences, even though efforts are being made to make a seamless transition.

She wondered if the population covered by the Medicaid Primary Adult Care program will understand the changes and be able to follow through quickly and sign up with another provider.

“I think they will need a lot of help. Some might realize the changes only when they go to a doctor the next time. They will need help from social-service providers,” Ostoich said. “This might also impact local organizations that serve the poor.”

Del. John P. Donoghue, D-Washington, who focuses on health care issues in the Maryland General Assembly, said he wanted to make sure the transition was smooth.

“I do not want massive confusion or people not being able to see their doctor or not get their health care because of the changes,” Donoghue said.

He said discussions are ongoing to “work things out. There are a lot of people working on this.”

For more information:

Patients with Maryland Physicians Care who are part of the Primary Adult Care program can call 1-800-977-7388 to choose a new managed-care organization.

According to the Maryland Department of Health and Mental Hygiene, those who do not do so by Dec. 21 will be automatically enrolled with another managed-care organization.

Those with questions can call 1-888-754-0095.

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