More than 8,100 Medicaid recipients in the Upstate will have to change their health plans after one company announced Wednesday it was pulling out of three counties.
An additional 5,200 recipients could also make the switch in three additional counties. Officials emphasized the problems were due to patient coverage and had little to do with Medicaid cuts approved earlier this year.
Absolute Total Care is one of seven Medicaid managed care plans offered by the South Carolina Department of Health and Human Services. In order for an MCO plan to work properly, enough doctors and hospitals have to agree to be a part of the plan’s network. That’s a problem for ATC in the Upstate, where it does not have enough providers onboard.
As a result, Health and Human Services will no longer offer the plan for Medicaid recipients in Spartanburg, Cherokee, and Union counties. “In this case in the Upstate, Absolute Total Care has had some issues with those network contracts,” agency spokesman Jeff Stensland said.
ATC is a subsidiary of Centene Corporation.
Under managed care, the state pays the company a per-member fee each month for every enrollee in the plan. The company then has to use that money to coordinate care for Medicaid recipients in its network. Stensland said not enough doctors were using the network to justify keeping it in the Upstate. ATC will continue to operate in other counties around South Carolina, where it has more than 84,000 members.
Medicaid recipients under the ATC plan living in the three affected counties will be required to choose from one of the other six managed care plans offered in South Carolina (although not all six are offered in every county). In addition, recipients in Greenville, Laurens, and Pickens County also have the power to switch if they choose. They can call (877) 552-4642 or visit scchoices.com for help.
While the agency did not say why providers were dropping ATC, South Carolina Medical Association past president Gregory Tarasidis said there were several possible reasons, including negotiations over reimbursement rates or hassles over payments to providers. However, he emphasized he does not know the specifics of this particular case.