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State Selects $4 Billion Medicaid Winners

ALBUQUERQUE, N.M. — Three familiar names are among the four companies chosen Friday by the state Human Services Department to share nearly $4 billion to provide Medicaid managed care to an estimated 700,000 people, starting Jan. 1.

HSD announced Friday that it had selected Blue Cross and Blue Shield of New Mexico, Molina Healthcare of New Mexico, Presbyterian Health Plan, and UnitedHealthcare Community Plan of New Mexico to manage medical, behavioral health and long-term care under the state’s Centennial Care program.

One familiar name, Lovelace Health Plan, was not on the list. Lovelace manages care for 91,000 Medicaid recipients today. It has a total of about 175,000 insurance customers.

Today, UnitedHealthcare is one of two companies that manage long-term care services for Medicaid recipients, and the other companies, plus Lovelace, manage medical care for Medicaid patients under the state’s Salud! program. A seventh company manages Medicaid behavioral health care.

Assuming the state secures federal approval, Centennial Care will replace Salud! and eight other major Medicaid programs, including behavioral health services, with a comprehensive program operated by the four companies named Friday.

Medicaid is expected to serve about 554,000 low-income children, disabled people and the elderly next year. Another 150,000 people are expected to get Medicaid coverage after the state expands Medicaid to low-income, able-bodied adults under terms of the federal Affordable Care Act.

HSD spokesman Matt Kennicott said federal approval of Centennial Care “is just a matter of time.”

Several Indian tribes continue to oppose Centennial Care’s requirement that Native American Medicaid recipients receive care that is managed by one of the insurance companies. Legislation that would strike that requirement is expected to be introduced in the current legislative session.

Kennicott said HSD expects to spend $3.9 billion on Medicaid in the coming fiscal year, of which $2.7 billion will come from the federal government.

Officials from the selected companies said the Centennial Care contracts should mean a significant increase in revenue and will require them to hire more people to deliver services. They said they had not estimated what their share of the 700,000-person market would be.

Blue Cross has 30,000 Medicaid members today, Molina has 89,000 and Presbyterian has 167,000. UnitedHealthcare and another company, Amerigroup, manage care for about 40,000 people.

In a statement, Lovelace said, “The notification from the New Mexico Human Services Department did not include details on why Lovelace Health Plan was not among the organizations chosen to manage the state’s Medicaid contract after 2013. LHP is in the process of seeking further clarification and looking at appeal options that are available.”

Lovelace added that its parent company, Lovelace Health System, will continue to provide medical services at its hospitals and pharmacies under contracts with Centennial Care companies.
— This article appeared on page A1 of the Albuquerque Journal