Excellus Dropping Out Of Medicaid Managed Care


Excellus Blue Cross Blue Shield's decision to stop participating in Medicaid health insurance programs for the poor and disabled in the north country won't take effect until January 1.

But when it does, it will affect thousands with limited access to health care.

St. Lawrence County Social Services Commissioner Chris Rediehs is hoping for a smooth transition when Excellus drops out of the Medicaid managed care and Family Health Plus programs.

His concern is whether affected individuals will be able to retain their current medical doctors or providers.

There are nearly 11,000 recipients enrolled in the Excellus Medicaid managed care plan in St. Lawrence County, nearly 10,000 in Jefferson County and 2,200 in Lewis County.

Excellus has notified participating providers by letter that it's pulling out of the two health insurance programs because it expected to lose about $100 million this year and the state isn't willing to increase reimbursements to offset losses.

Officials at Claxton-Hepburn Medical Center say insurance will still be available to individuals who were covered under the Excellus Medicaid managed care and Family Health Plus programs - only through a different provider like Fidelis or United Health Care Community Plus.

Under a managed care contract, the state pays an insurer a capped monthly fee to cover those enrolled.

Excellus spokesman Jim Redmond told us that while Excellus has a history of supporting safety net programs, the company can't continue to incur such large financial losses.

The state Health Department is looking at ways to place affected individuals into other public health insurance programs.

Friday, December 9, 2016
, Watertown, NY

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