EVERETT — At least 23,000 Medicaid patients are set to lose care access at more than 30 Optum clinics statewide this fall.
Starting Nov. 1, Optum Care Washington — a local branch of the global health care system that absorbed The Everett Clinic and The Polyclinic in Seattle — will drop primary and specialty care for patients with certain plans under Medicaid, the state insurance for low-income patients also known as Apple Health.
Almost 2 million Washington residents — about 21% of the state’s population — are enrolled in Apple Health. Last year, at least 40,000 enrollees lived in Snohomish County.
As of this week, Optum stopped accepting new adult patients with general Apple Health and UnitedHealthcare Community plans. On Nov. 1, Optum will cut the UnitedHealthcare Community Plan, according to a letter from Optum to patients last week.
UnitedHealthcare, the largest health insurer in America, still hopes to renew a contract with Optum. If it fails, it would have to find new providers for about 23,000 Medicaid patients, said Katie Pope, a spokesperson for the state Health Care Authority.
“Our goal is to keep these providers in our network and we remain open to further discussions,” UnitedHealthcare spokesperson Cole Manbeck wrote in an email. “In the event they leave our network, people enrolled in our Medicaid plan will continue to have access to a robust network of providers throughout Seattle, the Everett community and surrounding areas.”
The change comes as health providers nationwide work to close on insurance contracts in time for the 2025 enrollment period. It’s common for companies to postpone agreements while debating reimbursement rates — Providence, for example, is threatening to drop Aetna in December in a move that could affect 35,000 patients statewide, as reported by The Seattle Times.
Rory Graves, of Edmonds, said her family had to stop seeing their longtime doctors due to Optum’s battles with insurance companies over the past few years. And even with accepted insurance, she said, it’s hard to get care. After bouncing around to eight appointments trying to get a referral to see a rheumatologist, she’s ready to move on to a new care provider.
“It just feels like being nickeled-and-dimed to death every turn, and not getting the care I need,” Graves said. “I don’t feel like that would have happened when they were The Everett Clinic.”
Affected patients can either find new providers or switch to other plans Optum accepts, including Coordinated Care, another option with Apple Health. Some patients, including those who are pregnant or in active treatment, may have a short window of care past Nov. 1, according to a letter from Optum to UnitedHealthcare Community Plan patients last week.
“Supporting our patients with compassionate, quality care is our highest priority,” wrote Karrie Spitzer, a spokesperson for Optum Care Washington, in an email. “During this transition, we are focused on ensuring continuity of care and encourage our patients to reach out to us with questions or concerns.”
It’s unclear why Optum terminated or limited its contracts with Apple Health plans, including with UnitedHealthcare. Both Optum and UnitedHealthcare are part of UnitedHealth Group, one of the world’s largest clinic, pharmacy and insurance conglomerates.
Over the past five years, many clinics and hospitals across the state have struggled to overcome a workforce shortage and poor insurance reimbursement rates. But for Optum and UnitedHealth Group, decisions to cut state insurance plans come amid a time of financial growth.
As of July, Optum led UnitedHealth Group in a nearly $6 billion revenue increase year over year, contributing to companywide earnings of $98.9 billion in just three months, according to a second quarter earnings report. At the end of the past fiscal year, health care at Optum clinics worldwide brought in $95.3 billion.
The growth stems from a “commitment to ensuring high-quality, affordable care is available,” Andrew Witty, CEO of UnitedHealth Group, wrote in the earnings report.
This isn’t the first time Optum has struggled with insurers. In 2022, Optum and Regence BlueShield failed to reach a contract agreement after Optum demanded a 15.75% rate increase, risking insurance coverage for thousands of Everett Clinic patients.
Optum also faced criticism when it began charging Premera and its patients 50% higher rates — the highest in the state — a move that resulted in a lawsuit in King County Superior Court last year. Judges ruled in Optum’s favor.
Optum eventually renewed a limited contract with Regence, but terminated contracts with Regence and Aetna’s Medicare Advantage plans. Almost half of Medicare patients in the state have Medicare Advantage plans. After Boeing switched to Aetna Medicare Advantage, retirees had to choose whether to keep their insurance or stick with their doctors at Optum clinics. Optum and Aetna Medicare Advantage later agreed on a contract.
In addition to insurance contracts, Optum has made cuts in staff. Last August, Optum laid off at least 50 Everett Clinic workers, as well as an unknown number of workers from The Polyclinic. Layoffs have continued across the company. In July, Optum terminated the positions of more than 500 clinic and administration workers in California around the time it shuttered Virtual Care, the telehealth program it launched in 2021. The program offered 24/7 virtual access to physicians and nurse practitioners nationwide.
Correction: A previous version of this story wrongly stated the exact insurance plans Optum would cut.
Sydney Jackson: 425-339-3430; sydney.jackson@heraldnet.com; X: @_sydneyajackson.
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