Kriedler decision impacts Medicaid, exchanges

To The Eagle:

At Community Health Plan of Washington, we designed our Exchange products to provide high-quality, low cost options that meet the needs of our members. These plans offered unrestricted access to the entire First Choice Health Network, a robust commercial network of exceptional health care providers, and one of the most mature provider networks in Washington state. Our plans allowed members to control their out-of-pocket costs by offering comprehensive primary care and preventive health services with $0 copays and no coinsurance, through a group of Community Health Centers with more than 100 primary care clinics within the First Choice Health Network.

We worked closely with OIC staff for many months to ensure our Exchange products met all applicable legal and regulatory requirements, including network adequacy. Despite our ongoing engagement with the OIC, we received no indication that network adequacy was an issue that could impede approval of our plans until less than two weeks before the OIC deadline. Unfortunately, the OIC seems unable to move away from an outdated model of commercial insurance, which the Affordable Care Act was intended to reform. The OIC rejected our member-focused and innovative plans that were designed to address the unique needs of lower-income individuals who may experience “churn” between Medicaid and private insurance on the Exchange.

We hold that this decision harms Washington consumers and negatively impacts the most vulnerable populations by failing to address the key issues of marketplace choice and churn. Without meaningful choice or responsive solutions, enrollee uncertainty and anxiety in the marketplace will likely increase as members move in and out of eligibility brackets and find themselves without care options that enable them to continue seeing their trusted providers. These are their medical homes, and we had hoped to address these issues with our Exchange plans. We are regretful that the OIC’s decision will bar us from helping these communities in 2014.

(Community Health Plan of Washington provides managed care to more than 305,000 individuals and families throughout Washington State. Community Health Plan of Washington also offers Medicare Advantage plans and provides all eligible members the opportunity to enroll in the Children First™ Program which rewards regular prenatal and preventive child care. The health plan’s delivery system includes more than 590 primary care clinics, 2,622 primary care providers, over 14,400 specialists, and more than 100 hospitals.)