Excellus BlueCross BlueShield is withdrawing from New York's Medicaid managed care program amid steep losses.
The upstate New York insurer will stop offering Medicaid managed care plans during the early parts of next year -- after losing about $100 million in the program during fiscal year 2013.
"Losses of this magnitude are simply unsustainable," said Jim Redmond, Excellus communications vice president, in emailed comments.
"We have a long history of supporting safety net programs, but we can't do it at the expense of incurring huge financial losses," Redmond said. "We've had several meetings with the state. We value the state as a partner, but no meaningful changes have taken place that would have us continuing with the program. We are willing to reconsider if the financial situation changes and allows us to reduce the losses."
The discontinuation will affect more than 100,000 beneficiaries living in 25 counties throughout central New York, who will be transitioned to other insurers. Excellus is still participating in New York's CHIP program, Child Health Plus, and its subsidiary, Univera Community Health, will still cover Medicaid managed care beneficiaries in four counties.
Excellus, an affiliate of the not-for-profit holding firm Lifetime Holding Companies, is one of 17 insurers participating in New York's Medicaid managed care program, along with BlueCross BlueShield of Western New York, the Catholic non-profit Fidelis Care, MVP Health Plan, UnitedHealthCare and WellCare.
Excellus-covered beneficiaries may have several options, depending on which county they live in. Fidelis operates in many of the same counties as Excellus, and with close to half a million covered beneficiaries has one of the largest Medicaid managed care enrollments in the state.
Statewide, close to 3 million New Yorkers are covered under Medicaid managed care and the Family Health Plus program for moderately low-income individuals, which is being discontinued as the state expands Medicaid eligibility, and about 400,000 youth are covered through CHIP.