Not one year into New Hampshire's Medicaid managed care expansion, one physician-operated health plan is deciding to redirect its resources elsewhere, leaving other plans with new responsibilities.
Meridian Health Plan, a Detroit-based group of physician-owned and -operated health plans, is pulling out of New Hampshire's Medicaid managed care program, after helping the state start transitioning away from fee-for-service last year as one of three managed care organizations.
"This has not been an easy decision," said Meridian CEO David Cotton, MD, in a media release. "But our recent growth in the Midwest demands that we refocus our resources to continue to provide top-quality managed care products in our core markets."
Founded by Cottons in 1997, Meridian covers about 300,000 Medicaid beneficiaries through plans Illinois, Iowa, Ohio and Michigan, where it is the largest Medicaid HMO. The organization launched a pharmacy benefits arm in 2011 and came to New Hampshire in 2012 on a contract that eventually began in 2013 and was valued at more than $2 billion through 2015 -- the largest of the three in the state.
Now, two other managed care organizations --New Hampshire Healthy Families and Well Sense Health Plan -- will absorb some of Meridians 30,000 members and the rest of the contract.
After Meridian
New Hampshire Healthy Families is a part of Granite State Health Plan, a subsidiary of the St. Lous-based for-profit company Centene, which is rumored to be a potential acquisition target and health plan launching pad for the health system Ascension Health. Well Sense is a not-for-profit health plan operated by Boston Medical Center Health Plan and using Harvard Pilgrim's provider network in New Hampshire Medicaid.
"We will work quickly with the company to develop a transition plan that protects Meridian members," said New Hampshire Health and Human Services Commissioner Nicholas Toumpas.
Meridian will continue its services for beneficiaries and reimburse providers until July 31, and the transition details will be worked out in the next month, Toumpas said.
The rollout of the new Medicaid program dates back to 2011, when the state legislature voted to move to a managed care system. "Progress in network development was initially slower than anticipated, delaying the program start," the NH HHS noted last year.
The program eventually began last fall in the first of three phases, with managed care covering all services except dental and long-term care. Some 120,000 have enrolled either voluntarily or on a mandatory basis to date, 25 percent of them with Meridian, 34 percent with Centene's Healthy Families and 41 percent with Well Sense.
The second phase will include long-term care -- although that has been challenged by some community groups and no date has been set-- and a third phase would include new beneficiaries enrolling under the state's participation in Medicaid expansion.