State program to help ease Medicaid logjam

Published 9:00 pm Thursday, January 1, 2004

In a breakthrough for providing health care for the poor in Snohomish County, up to 20,000 children and adults will be guaranteed access to medical clinics this year through the state’s Healthy Options program.

The agreement will help ease a logjam that for three years has blocked access to medical care by tens of thousands of Medicaid patients in the county.

The changes are expected to be complete in March, according to the state Department of Social and Health Services. Affected children and adults will be notified this month that they are being assigned to a health care plan.

Patients don’t have to wait until March to see a doctor. Once enrolled, they can contact their clinic for service, DSHS spokesman Jim Stevenson said.

DSHS worked out the deal with Molina Healthcare. The cost of the program to the state will depend on the number of patients each doctor sees.

Molina Healthcare of Washington contracts with medical groups such as The Everett Clinic, Medalia Medical Group, Pacific Medical Center’s Lynnwood clinic and local independent medical clinics, such as Goodman and Stoller Family Medicine in Everett, to provide health care, said Ann Koontz, Molina’s chief executive.

Healthy Options patients also can get health care through the nonprofit Community Health Center of Snohomish County clinics or Sea Mar Community Health Center in Marysville.

So far, 135 doctors in Snohomish County have agreed to take new Healthy Options patients.

"There will be good access for people," Koontz said.

The Everett Clinic, which operates 10 clinics in the county and cares for 270,000 patients, announced in August that it would accept at least 2,500 Healthy Options patients in 2004, the first time in nearly three years it had opened its doors to those new patients.

"The Everett Clinic is such a large provider that was really an important key in expanding access to Healthy Options clients," said MaryAnne Lindeblad, who works in program support for DSHS.

However, The Everett Clinic now expects to take up to 6,000 new Healthy Options patients, spokeswoman Cynthia Scanlon said.

With better reimbursement rates and The Everett Clinic taking on so many new Healthy Options patients, others joined in a snowball effect.

Essentially a health maintenance organization for pregnant women and patients who are unemployed and on welfare, Healthy Options also serves the state’s Children’s Health Insurance Program patients — health care for children under age 19 whose families meet income guidelines.

While the news was good for up to 20,000 Healthy Options patients, it still leaves an estimated 25,000 blind, disabled and elderly Snohomish County Medicaid patients not eligible for Healthy Options without guaranteed access to health care, Lindeblad said.

In 2002, DSHS officials said that Snohomish County was one of the three worst counties in the state for access to health care for Medicaid patients.

A survey by the Snohomish County Medical Society in the fall of 2002 found that only 5 percent of 325 primary care doctors working in private medical clinics were openly accepting new Medicaid patients because of low reimbursement rates paid by the state. By August 2003, only 12,375 of the 76,918 children and adults on Medicaid in the county had guaranteed access to a doctor through Healthy Options, Stevenson said.

Also in August, Group Health announced it would drop its 1,814 Healthy Options patients in Snohomish County effective Jan. 1. Those plans have not changed.

The overall problem began three years ago when the state rejected bids from five managed care plans to serve Healthy Options patients in Snohomish County in 2001, triggering a crisis in health care for the poor.

Many patients who can’t get in to see a doctor end up in the emergency rooms at local hospitals, one reason Providence Everett Medical Center had the busiest emergency department in the state in 2002.

Nearly 30 percent of all patients treated in the hospital’s emergency department in 2003 were Medicaid patients, said Dr. Tony Roon, trauma director. Another 15 percent had no health insurance.

Reporter Sharon Salyer: 425-339-3486 or salyer@heraldnet.com.