Molina Healthcare of New Mexico is assuming a Medicaid managed care contract from Lovelace Community Health Plans, after the health system-owned insurer lost a bid to participate in the state's new Medicaid program.
By August, the two organizations say, roughly 84,000 Medicaid beneficiaries will be transitioned to Molina's health plan.
That'll bring Molina's total Medicaid managed care membership in New Mexico to 175,000 beneficiaries, surpassing the roughly 167,000 members under the contract of Presbyterian Health Plan, a subsidiary of another health system, Presbyterian Healthcare, the state's largest.
Ron Stern, president and CEO of Lovelace Community Health Plans parent organization, Lovelace Health System, said that "members will continue to have access to Lovelace providers, medical staff, Lovelace Retail Pharmacies and Lovelace's network of hospitals."
Molina, which also owns two primary care clinics in New Mexico, is one of four managed care organizations selected for a revamp of the state's Medicaid program, called Centennial Care, that's officially starting in 2014 under a federal section 1115 waiver.
The Medicaid membership numbers between those four MCOs may be changing a bit as the new program is finalized.
Starting later this year, the roughly 700,000 New Mexicans using Medicaid will have the choice of enrolling in one of the four MCOs: UnitedHealthcare Community Plan, Blue Cross Blue Shield New Mexico, Molina and Presbyterian.
As Medicaid costs rose to 16 percent of the state's budget in the 2012 fiscal year, the Centennial Care program was born out of the New Mexico legislature's concerns over rising Medicaid costs, including those from the roughly 130,000 residents expected to gain coverage under eligibility expansion.
The program pared back the number of MCOs from seven to four, expands cost sharing for beneficiaries and includes pay-for-performance policies targeted at encouraging "the right care, in the right place, at the right time," said New Mexico Human Services Department Secretary Sidonie Squier, who formerly worked at HHS's Office of Family Assistance, the Texas Health and Human Services Commission and the Florida Department of Children and Families.