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Excellus may drop 25,000 NNY customers

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More than 25,000 people across Jefferson, Lewis and St. Lawrence counties may have to switch their Medicaid Managed Care or Family Health Plus insurance program provider, as Excellus BlueCross BlueShield is making plans to drop out of those programs, effective Jan. 1.

Excellus, however, is working with the state Department of Health to try to avoid that. According to an Oct. 8 letter sent to participating providers, the health plan in 25 counties “is incurring losses approaching $100 million in 2013,” which is expected to increase next year. Excellus Vice President of Communications Elizabeth Martin said that loss is due to “inadequate state reimbursement rates.”

She said Tuesday that Excellus would “willingly reconsider if the financial situation changes and allows us to reduce the losses.”

According to the Oct. 8 letter, Excellus’s “preference would be to stay in the Medicaid Managed Care and Family Health Plus programs. We have a long history of supporting safety net programs but we cannot continue to do so while incurring such large financial losses. We have had several meetings with the state throughout 2013 to see if the losses that we and other upstate health plans are incurring could be addressed.”

St. Lawrence County Department of Social Services Commissioner Christopher R. Rediehs said he doesn’t know the full story yet.

“I’ll trust we’ll know more in the coming weeks,” he said.

Excellus has 10,574 St. Lawrence County residents enrolled in Medicaid managed care, while Jefferson and Lewis counties have 9,876 and 2,225 people enrolled, respectively. A total of 1,281 enrollees in Jefferson County, 272 in Lewis County and 1,283 in St. Lawrence County use Excellus’s Family Health Plus plan.

Jefferson County Department of Social Services Commissioner Laura C. Cerow said the department already has fielded some calls on the subject. Both Excellus and the state Health Department are expected to release more information in the coming weeks.

If reimbursement rates do not change, and Excellus goes through with the dropout plan, Mrs. Cerow said, Excellus enrollees then should be automatically enrolled in another Medicaid or Family Health Plus plan. For Jefferson County, she said, that would be United Healthcare.

“Originally, the department of Health put out that each county would have two providers for managed care,” she said. “They changed it to one. I’m hoping consumers here have a choice. I’ve heard there are other managed care providers interested in Jefferson County.”

Mr. Rediehs said the state is “very enthusiastic to make sure people have options.”

If not, people would be enrolled automatically in the sole available plan. For St. Lawrence and Lewis counties’ Excellus enrollees, that means Fidelis would step in.

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