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Governor’s Commission on Medicaid Care Management — Update on Meridian Withdrawal and Step 2

Posted: June 6, 2014

Governor’s Commission on Medicaid Care Management — Update on Meridian Withdrawal and Step 2

June 5, 2014

Commissioner Toumpas’ remarks around the meeting focused on 1.) six month status update for Medicaid care management, 2.) Meridian’s withdrawal and transition plan, and 3.) the NH Health Protection program (Expansion).

Of particular note around Meridian, Commissioner Toumpas reported out the following:

1.) short term, for clients with Meridian, nothing changes — clients still attend appointments and providers still bill and are paid as they are right now

2.) Families will be getting a letter directly from Meridian confirming the withdrawal.

3.) DHHS is mailing letters out June 6 to clients enrolled with Meridian.

4.) Clients will have until July 10 to choose another health plan — either NH Healthy Families or WellSense.

5.) If clients do not select a health plan by July 10th, they will be auto enrolled with either NH Healthy Families or WellSense.

6.) Clients have an opportunity to switch plans within 90 days of enrollment.  So, if a client is auto enrolled and they are not satisfied with the health plan, they can move to the remaining health plan.

7.) If a client is voluntary (dual), and currently enrolled with Meridian, or any other health plan, the client may opt out at any time.

8.) The State recognizes that having Boston based providers, especially Boston Children’s Hospital in network with a health plan or all health plans, is important for continuity of care for those with complex medical concerns.  The State has scheduled a meeting next week with Boston Children’s Hospital to speak to this issue.

9.) Meridian will pay for services to providers up until the end of July 2014 and providers have until July 2015 to submit invoices for processing.

10.) “Continuity of care is a priority and we are trying to keep this transition seamless and smooth.” He indicated that a cross-disciplinary team is in place, with Carol Sideris from Client Relations, taking the lead for communications and other priorities; “like working with the plans to make sure that Meridian’s PAs are honored by the other 2 plans.”

The Q&A at the end by Laurie McCray, with ABLE NH, focused on what true quality care means to the vulnerable with questions around Boston Children’s Hospital.  Laurie collected concerns from pediatrician’s on the Seacoast that she presented to Commission Members.

-In addition, Rich Crocker respectfully asked when the financial data would be made public relative to the “average” 8% rate increase that is part of the “refreshing of the rates” through MCO contract amendment that is scheduled for G&C on June 18th.

– John Richards, following Lorene and Susan’s presentation, asked a question, directed to Lorene, along the lines of: “Do you have a construct or a concept as to how you will preserve the area agencies and still keep MCOs with a ten percent overhead?”  Lorene passed the question along to the Commissioner who said that was the one question he expected to get at today’s meeting and explained as follows: “I don’t have a plan.  I do know you would be hard pressed to find a state that is not looking at this now, but we were a bit ahead. With Step 1 we have a solid foundation on which to build … and we are aiming to focus on quality, outcomes, and the better integration of care … the key principle is looking at the whole person … we are designing an organization so that client facing work is organized around the person we are serving … we need to look at populations in a more holistic way … Step 2 requires better coordination around the whole person and these populations represent a significant amount of the cost …That’s what Lorene and Susan will work through.”

Around expansion, Commissioner Toumpas noted that the state is most likely “not looking at July 1.”

The meeting was videotaped and will be posted, along with the presentation materials and a commentary for Commissioner Roberta Berner, around seniors, LTC, and health homes.  Click here for further information:


Below please find the PowerPoint presentation Lorene Reagan and Susan Lombard gave at yesterday’s Governor’s Commission meeting held in Portsmouth around Step 2.

MCM PowerPoint June 2014


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