Nearly Half Of Hoosiers In Medicaid Program Must Switch Plans After MDWise Exit

Mar 2, 2017

Credit Michael Havens / https://www.flickr.com/photos/128733321@N05/

Almost half of the 95,000 members enrolled in the state’s Hoosier Care Connect health care program will need to switch their plans this month after one of the three companies offering coverage makes its exit.

MDWise, an Indianapolis-based company, announced late last month the company was dropping out of the program.

Leaders at MDWise contend it’s not financially feasible to renew a contract with the state, even though Indiana Family and Social Services Administration spokesman Jim Gavin says the administration’s actuary says the rates are fair.

“Those capitation rates — that means the rates that are paid by the Hoosier Care Connect program to those managed care entities per month to coordinate the care of each member — that those rates were adequately and appropriately set to serve members,” says Gavin.

MDWise said in a notice filed with the Indiana Department of Workforce Development, “Unfortunately, MDWise was unable to secure rates needed to continue its participation in the program.”

Hoosier Care Connect offers premium-free healthcare to the some of the state’s most difficult-to-treat patients. The program covers disabled, blind and elderly Hoosiers who aren’t eligible for Medicare.

The announcement comes during a transitional period for insurance companies, many of which claim they’re being squeezed by the Affordable Care Act. 

Gavin says he’s not worried about the remaining two insurers offering coverage through the program. 

We’re very happy that Anthem and MHS are continuing with us, those rates have also been approved by CMS,” he says.

Approximately 40,000 of Care Connect’s members are enrolled in the program through MDWise, so they’ll have to switch to one of the other two companies offering services, Anthem or MHS, before the middle of March. If they don’t switch themselves, Gavin says the FSSA will move them to one of the providers based on their primary care physician.

Hoosier Care Connect launched in 2015 shortly after the unveiling of HIP 2.0.

Close to 80 MDWise employees will lose their jobs as a result of the move, the majority of whom are case managers.

MDWise could not be reached for comment.