More on Reimbursement

Medicaid Digest week ending November 3, 2012

UnitedHealth exits S.C. Medicaid market; Vermont urges state workers to enroll their kids in CHIP; and Washington Medicaid will cover autism therapy in this week's Medicaid Digest.

UnitedHealth sells S.C. Medicaid business to WellCare

UnitedHealth Group announced last week that it would be exiting the South Carolina Medicaid market at the end of the year and has sold its business there to Florida-based WellCare Health Plans.

The sale is expected to close by the end of the year and will transfer insurance coverage to WellCare for roughly 65,000 people in 39 of South Carolina's 46 counties. While the sale divests UnitedHealth of it Medicaid business in the state, it still has more than 300,000 members in the state: 255,000 in its employer-sponsored health plans and 75,000 enrolled in Medicare Advantage plans.

WellCare Health Plans provides managed-care services targeted to government-sponsored health care programs, focusing on Medicare and Medicaid. The company serves approximately 2.6 million members nationwide.

Vermont urges state employees to move kids onto CHIP program

Vermont Gov. Peter Shumlin has asked state employees to consider dropping their children from their state-sponsored health plan and move them to Dr. Dinosaur, Vermont's version of the Children's Health Insurance Program (CHIP) for low income kids, a move the state contends could save both the parents and the state a lot of money.

To encourage the program, the state sent letters to roughly 2,100 state employees who met certain income threshold encouraging them to make the voluntary change, according to a news report on Vermont Public Radio. Currently, families earning up to 300 percent of the federal poverty level – about $56,000 for a family of three – are eligible for the program.

According to information supplied by the state, a single parent with two kids could save as much as $2,000 a year in insurance premiums by making the change. In addition, if half of the eligible state employees make the switch to the program, the state would save as much as $5 million per year.

Lawsuit settlement provides autism treatment for Medicaid

Nearly 9,000 children in Washington State with autism spectrum disorders insured by the state's Apple Health program, including those on Medicaid, will be covered for Applied Behavior Analysis  (ABA) therapy under a U.S. District Court lawsuit settlement approved last week.

The lawsuit was filed by Northwest Justice Project, in the wake of similar settlements in other class-action suits against insurers' limits or exclusions of neurodevelopmental and behavioral therapies.

Scott Crain, staff attorney for the Northwest Justice Project, said the agency worked with the state's Health Care Authority to craft the settlement. MaryAnne Lindeblad, Health Care Authority director, said in a story published in the Seattle Times that recent evidence shows the therapy is effective and "deserves to be covered by our benefit structure."

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