Blue Cross drops out of RIte Care program

BLUE CROSS was one of three insurers in the RIte Care program, the state Medicaid managed care program that covers low-income children and some parents. It had a relatively small share of enrollment, only 15,163 of a total of 110,713 members as of July 31, according to state figures. /
BLUE CROSS was one of three insurers in the RIte Care program, the state Medicaid managed care program that covers low-income children and some parents. It had a relatively small share of enrollment, only 15,163 of a total of 110,713 members as of July 31, according to state figures. /

PROVIDENCE – Blue Cross & Blue Shield of Rhode Island will no longer cover RIte Care beneficiaries as of Jan. 1, ending a 17-year run in the program because of what a spokeswoman called a “bandwidth issue” – too many competing programs involving the underserved.
Blue Cross was one of three insurers in the RIte Care program, the state Medicaid managed care program that covers low-income children and some parents. It had a relatively small share of enrollment, only 15,000 of about 120,000 members.
Neighborhood Health Plan of Rhode Island, a Medicaid-only nonprofit plan set up by community health centers when RIte Care was created in 1993, covers the majority of beneficiaries, about 75,000. UnitedHealthcare of New England covers the rest.
The R.I. Department of Human Services announced last week that it had recommended Neighborhood and United, the only two bidders, for a new three-year contract that begins Sept. 1. Blue Cross did not submit a bid.
In a news release, state officials said they would work closely with Blue Cross “to assure a smooth transition” of its RIte Care members before the year’s end. Blue Cross will notify its RIte Care members about transition plans, officials said.
Medical benefits will continue without interruption, officials stressed, and an initial review by the state has found that 98 percent of Blue Cross members who switch to Neighborhood and United will be able to continue to receive care with their current primary care providers.
Within RIte Care, Neighborhood has generally been the most active in working with providers and with the state to shape and improve the program, but Blue Cross appealed especially to families who had previously been covered by an employer-sponsored plan with the company, or families in which the parents were still with Blue Cross.
In a written statement, Laura Calenda, assistant vice president of corporate communications for Blue Cross, said the company participated in RIte Care “for many years, and remains a sincere supporter.”
“After careful consideration, however, we have determined that for the near term, our greatest immediate opportunity to assist Rhode Islanders in need lies in supporting federal health care reform by administering the new high-risk pool and continuing to serve as the state’s insurer of last resort,” Calenda added.
“Current RIteCare members should rest assured that they will continue to have coverage, and that we will work with the Department of Human Services to ensure a smooth transition to a new provider,” she said. After the high-risk pool program ends, in 2014, Blue Cross may consider returning to RIte Care, she added.
Along with the new RIte Care contracts, the state last week announced that it will sign new contracts with Neighborhood and United for Rhody Health Partners, a Medicaid managed care program that covers about 12,000 adults with disabilities or chronic conditions. Blue Cross is not currently part of that program.
In a news release, Gary Alexander, secretary for the Executive Office of Health and Human Services, noted that both Neighborhood and United rank among the top dozen Medicaid managed care plans in the country, according to the National Committee on Quality Assurance. Blue Cross has also consistently done well in those rankings.

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