Changes threaten patients’ patience

Medicaid recipients face scant options under new system

By SHARON SALYER

Herald Writer

Nearly 23,000 low-income adults and children in Snohomish County could soon face this troubling question: Where will I get my health care next year?

Healthy Options, or Medicaid patients who get their care through Aetna, Group Health, Molina, Northwest Washington Medical Bureau and Regence health plans, will have to switch to medical coupons beginning Jan. 1.

The coupons for people with low incomes qualify patients for free medical service, but there’s no guarantee clinics will accept them.

The change follows the state’s rejection of the bids from five managed care plans to provide care to Healthy Options patients in Snohomish County next year.

Some area health care professionals worry this could trigger a crisis in caring for the poor — that some patients who need medical care won’t be able to get it when they need it.

Others wonder if patients unable to get care at clinics will stream to hospital emergency rooms, where physicians trained to deal with life-threatening problems caused by car crashes and heart attacks will be confronted with patients seeking treatment for colds or their baby’s earache.

Healthy Options patients of the nonprofit Community Health Center of Snohomish County and Sea Mar in Smokey Point will continue to get care as they now do.

To qualify for Healthy Options, the gross monthly income for a family of four cannot exceed $2,841.80. There are no deductibles or out-of-pocket costs.

Even though medical coupons theoretically can be used to get care at any medical clinic, based upon the experience of Medicaid patients from the early 1990s, when they were last widely used in Snohomish County, they could face significant problems in getting medical care.

"I once heard a person describe it as a license to hunt for a doctor," Pam MacEwan, vice president for public policy for Group Health, said of the obstacles to using medical coupons.

Patients will have to call individual medical clinics to see if they are accepting medical coupons. Clinics are not required to see Medicaid patients.

Currently, no matter which health plan Healthy Options patients are enrolled in, they can walk in to their assigned clinic and get care, explained Bob Moore, who oversees state and federal health care plans at Group Health.

In January, "you’re going to have to freelance," he said.

The situation at Group Health, which treats nearly 3,000 Healthy Options patients at its clinics in Everett, Monroe and Lynnwood, is an example of the confusion that could result.

Asked if the cooperative will continue to see its Healthy Options patients next year after its contract with the state expires, Moore said: "Unfortunately … I can’t give you a categorical yes or no answer."

The reason: what clinics get paid by the state to care for Medicaid patients is far short — as low as 40 percent — of what it costs to care for the patients, health care professionals report.

"If there’s health care supported by the government at a level where we weren’t losing money taking care of them, it wouldn’t be an issue." said Dr. Jack Stephens, a Harbour Pointe pediatrician.

"It’s a little like Safeway trying to sell Cheerios at 95 cents a box to one population and $2.35 to another," he said of the difference in reimbursement rates between Medicaid and traditional health plan patients.

Doctors feel squeezed by the competing pressures of patients who need to be seen and economic realities, Stephens said.

The result: Medicaid patients "may be able to get into their established primary care provider, but some won’t," predicted Desmond Skubi, director of the nonprofit Community Health Center of Snohomish County. "Some may be able to get in this time, but not the next."

Short of turning them away, there are ways of discouraging these patients, said Ray Crerand, chief executive of Providence Everett Medical Center.

"The way they do that is by saying … ‘I’ll see you in 10 weeks,’ " he said.

While two of the biggest clinics in the county say they will continue to see their current Medicaid patients next year, one of the biggest questions is whether local clinics will accept new Medicaid patients.

"We don’t have a philosophy of turning away patients who are already with us," said Dr. Earl Beegle, chief medical officer for the Medalia Medical Group, which cares for 3,400 Healthy Options patients at its 12 area clinics.

Yet Beegle said it would be "very difficult to economically survive" by taking new Medicaid patients.

The Everett Clinic, which treats 6,000 Healthy Options patients, hopes to automatically transfer them to the new system, but hasn’t made a decision on accepting new Medicaid patients, said Rick Cooper, the organization’s chief executive.

It’s up to the state’s Medical Assistance Administration to either accept or reject annual bids to provide health care for Medicaid patients in each county.

"We offered an opportunity for all the health care plans in the state to contract with us," and indicated what the state would be willing to pay for the service, acting director Diane Weeden said.

Health care plans "make corporate decisions whether they choose to contract with us or not," she said. "It’s not an easy decision for either us or the plans."

Ultimately, the bids by Regence and the four other health plans serving Healthy Options patients in the county were deemed too high.

Costs not covered by the government for caring for Medicaid patients are split between health care plans and physicians, Regence spokesman Chris Bruzzo said. Regence provides health care to more than 12,000 Healthy Options patients in Snohomish County and some 80,000 in Western Washington.

The company lost $1.1 million on the coverage in 1999, Bruzzo said, while physicians lost another million.

Healthy Options was established in Washington in 1992. Its goal was to cut the state’s medical costs by assigning Medicaid patients to a specific doctor or clinic through a managed care plan and provide more consistent care for patients.

"If there’s a poster child for the benefits of managed care, it was Healthy Options," Stephens said.

Before the program began, "there was a big population where their care was going from doctor to doctor or no doctor," he said, instead using hospital emergency rooms, where the cost of providing care is far more expensive than in a medical clinic.

"I do see this in some measure as a step backward," he said of the switch back to medical coupons.

Not all physicians agree.

When Healthy Options was established, there were promises of patient education and assistance with follow-ups on immunizations, said Dr. Judith Babcock, a family practice physician at the Birth And Family Clinic in Edmonds.

"We never really saw that," she said.

"Certainly we’ll keep our patients," she said of the clinic’s policy toward Medicaid patients. "We treat them the same no matter what their insurance plan may be."

Yet Stephens wonders whether physicians will fully know the effects of the change.

"All doctors live in a system where they’re insulated from the people they don’t see," he said.

"I have no way to track the people who won’t be seen, the people who will be turned away."