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Community Hospital pushing patients to switch Medicaid plans

Grays Harbor Community Hospital has canceled its contracts with its Medicaid providers, which could leave thousands of low-income residents scrambling to find a new health provider in the coming weeks.

Community Hospital canceled the contracts in December and has been working with providers to get higher reimbursement rates. It’s still possible that the hospital will work out a contract with at least one of the state Medicaid insurance providers, hospital spokesman David Quigg said. But what that really means is that if patients are not on a state plan that the hospital accepts, they will be paying “out-of-network” costs — which would mean a lot more money coming out of pocket for those low-income hospital users.

This shouldn’t impact private health insurance plans, but consumers still may want to check to ensure their doctor is “in network” to make sure they are receiving the full benefits of their health insurance plans.

Community Hospital has been struggling with low revenue in recent years because more and more residents are relying on government health insurance plans that don’t cover the full costs of hospital services. As of May, 77 percent of the hospital’s providers depend on government health insurance plans. Of those, 30 percent are on Medicaid.

The hospital will go to the ballot in August with hopes of becoming a public hospital district to get better reimbursement rates and a potential property tax. But the hospital has already been taking steps to increase revenue — including getting better rates from the state health providers.

The state has five service providers that it assigns low-income residents who qualify for state paid health coverage. There are 21,888 adults and children, as of last month, who qualified for Medicaid coverage on the Harbor. Molina has the most patients at 11,310, United Health Care has 3,392 clients, CHPW has 3,686 clients, Coordinated Care has 2,765 clients and Amerigroup has 735 clients in the county.

At this point, Quigg says that the hospital is working with the contractors to get better contracts with four out of the five providers. United Health Care notified the hospital and its patients on June 1 that they will no longer provide “in-network” coverage at the hospital. That means United Health Care patients could still use the hospital, but would be paying a lot more out-of-pocket costs. As of last week, the hospital was still working on agreements with Amerigoup and Coordinated Care.

Quigg noted Friday that it’s looking more likely that the hospital could just have a contract with one provider out of the five — and the largest provider of them all, Molina, may not be covered by the hospital anymore.

Quigg said hospital officials anticipate announcing soon which providers they will work with in the future.

As of Tuesday, nothing had been announced by the hospital and no press releases issued dealing with the providers.

However, if that one provider accepted by Community Hospital is Coordinated Care, it could really impact health care in East County because the clinics operated by Summit Pacific Medical Center accept every state Medicaid plan — except Coordinated Care, Summit Pacific Chief Financial Officer Will Callicoat says.

That could mean someone seeing a physician on the Molina plan at the Summit Pacific-run clinic in Elma would likely not be referred to Community Hospital for a surgery and would have to go to Olympia.

Summit Pacific CEO Renée Jensen notes that Summit Pacific does accept Coordinated Care in its emergency room, just not its clinics.

“I completely understand what Grays Harbor Community Hospital is doing to have a more narrow insurance pool,” Jensen said. “And that’s a trend you’re seeing across the state. It’s actually more unusual that we’re accepting all of them. As we look to reduce the overall cost of health care, this is a step we may have to take as well.”

Callicoat said that the trend for Summit Pacific is to accept anyone who walks in their doors at their clinics. If they have been on Coordinated Care, the hospital just writes off the bill for that one visit and helps facilitate to move them on to one of the other four state health providers.

Quigg said that the hospital will have more to announce about which contracts they’ve worked out in the near future.

“The providers that we no longer accept will have to transition to another provider,” Quigg said.

This will impact not just Community Hospital itself, but its clinics, including the one in Montesano.

Quigg adds, “Because this can be confusing and difficult, we will be opening an enrollment center on the east campus and people can come in person and we will help walk them through this system. It will be open Monday, 9 a.m to noon and 1 p.m. to 3 p.m. … In the end, we’re looking for a smaller number of providers to partner with. How can we best juggle patient needs and make sure it’s a good fit for all for them to partner with us.”

Quigg says it’s pretty easy to get people to change to the right Medicaid health provider plan. It just takes a phone call and is changed the following month by the state.