What to know as deadline looms in Anthem Medicaid dispute with Nationwide Children's

Max Filby, The Columbus Dispatch
·3 min read
2
Emily Crawford holds her 4-month-old baby Sage Crawford's hand in their home. Emily has had to navigate finding a new health plan while caring for Sage through multiple heart surgeries. The Medicaid that previously covered Sage through Anthem does not cover treatment at Nationwide Children's Hospital.
Emily Crawford holds her 4-month-old baby Sage Crawford's hand in their home. Emily has had to navigate finding a new health plan while caring for Sage through multiple heart surgeries. The Medicaid that previously covered Sage through Anthem does not cover treatment at Nationwide Children's Hospital.

With a deadline to change Medicaid plans just days away, Nationwide Children's Hospital remains out of network for thousands of Columbus-area kids covered by Anthem

Anthem has extended another offer to Nationwide Children's, both the hospital and insurer have confirmed. But a deal has yet to be reached to cover care for some 5,600 kids in central and southeast Ohio who are on Anthem's Medicaid plan at Nationwide Children's.

Nationwide Children's has encouraged Ohioans to try to switch Medicaid plans by May 1 if they have children that are insured by Anthem. Ohioans were given 90 days — or until May 1 — to change their Medicaid plans after the state rolled out changes to its Medicaid program on Feb. 1.

Read More: Anthem Medicaid dispute with Nationwide Children's jeopardizes healthcare access for thousands

The lack of a deal caught the attention of local politicians in the days after a Dispatch story reported that negotiations between the hospital and health insurer had stalled.

" I call on Anthem Medicaid to return to negotiations today," Columbus Mayor Andrew J. Ginther said in a prepared statement this week. "Lives of our children are literally at stake.”

Medicaid is the government insurance program that covers people with limited income and those on disability, according to the Ohio Children's Hospital Association. There are roughly 1.3 million children on Medicaid in Ohio.

Ginther wasn't the only area leader to speak out about the contract negotiations.

Franklin County Commissioner Erica Crawley expressed her frustrations with the status of talks. She said the lack of a deal creates a "a troubling level of uncertainty" and she feared the fallout could potentially be "disastrous" if a solution wasn't reached soon.

“It is unacceptable that Anthem is using vulnerable children as a bargaining chip," Crawley said. "Due to their inability to reach an agreement with Nationwide Children’s, as every other Medicaid insurer in Ohio has done, the health and wellbeing of thousands of children is at risk."

Although a contract hasn't been reached, an Anthem spokesperson said it is working diligently to reach one with Nationwide Children's.

Read More: Lyme disease cases skyrocket across Ohio. Here's what you need to know now

Anthem's latest offer to the hospital is one that keeps fiscal responsibility and the sustainability of the state's Medicaid program in mind, said Buddy Castellano, an Anthem spokesman. The insurer already has entered contracts with a Toledo location of Nationwide Children's and other pediatric hospitals in Dayton, Cincinnati and Akron, Castellano said.

Anthem has more than 800 pediatricians in the greater Columbus area in its Medicaid network, meaning families have options besides traveling out of town for care, Castellano said. Anthem, he said, is also willing to cover the cost of any needed emergency care, regardless of whether a hospital is in-network or not.

Anthem Blue Cross Blue Shield of Ohio is the only Medicaid plan in Ohio that currently considers care at Nationwide Children's to be out-of-network, according to the hospital.

Ohio's six other Medicaid insurers consider the hospital to be in-network, meaning they'll cover the cost of care. Those plans include AmeriHealth Caritas Ohio, Buckeye Health Plan, CareSource Ohio, Humana Healthy Horizons, Molina HealthCare of Ohio and UnitedHealthcare Community Plan of Ohio, according to the hospital.

Nationwide Children's has continued to care for kids on Anthem's Medicaid plan for now, in anticipation that a deal may be reached at some point. But continuing to do so indefinitely is unsustainable for the hospital, which could eventually be forced to send kids covered by Anthem elsewhere for care, said Dr. Rustin Morse, chief medical officer at Nationwide Children's.

"We are committed to uninterrupted care as long as possible," a prepared statement from the hospital said. "We only seek an agreement that is equitable to the model and structure we maintain with all of Ohio’s six other Medicaid managed care plans."

mfilby@dispatch.com

@MaxFilby

This article originally appeared on The Columbus Dispatch: Thousands of kids on Medicaid not covered at Nationwide Children's