Editor’s Note: This update is provided to clarify a potential factual inaccuracy. Mercy Care remains committed to the Arizona Medicaid market and continues to serve its members. The recent developments, including the state’s decision to pause member transition activities, are specific to the ALTCS E/PD procurement and do not impact Mercy Care’s other vital services in the state.
Phoenix, AZ – A looming crisis threatens Arizona’s healthcare safety net, particularly for seniors, as 2 of the top 3 insurers exit the state’s Medicaid program and a single entity, Arizona Complete Health (ACH), rapidly expands its footprint. This seismic shift in the healthcare landscape, coupled with concerns about Arizona Complete Health’s practices, is sparking fears of reduced access to quality care and predatory pricing.
Administrative Judge Halts Transition, Underscoring RFP Concerns
In a move that underscores the gravity of the situation, an Administrative Law Judge (ALJ) is pausing the transition of Arizona Long Term Care System/Elderly & Physically Disabled (ALTCS-EPD) members to new health plans. The ALJ found the Request for Proposals (RFP) process to be “arbitrary,” echoing concerns raised by insurers who argued that the flawed RFP could jeopardize the quality of care for thousands of Arizonans relying on ALTCS-EPD services.
The Arizona Health Care Cost Containment System (AHCCCS), the state’s Medicaid agency, must now decide whether to accept, reject, or modify the ALJ’s recommendation by September 9, 2024.
Arizona Complete Health’s Rapid Ascent Raises Red Flags
With the exit of 2 major insurers Banner Health and Mercy Care from the AHCCCS market, Arizona Complete Health, a subsidiary of Centene Corporation, has swiftly filled the void. However, ACH’s rapid growth has triggered alarm bells. Critics allege the company is engaging in predatory pricing strategies, potentially cutting costs at the expense of seniors and healthcare providers, particularly during a period of high inflation.
With minimal competition remaining in the market (only ACH and UHC), there are fears this could further reduce reimbursement rates, squeezing providers already grappling with rising operating costs. This could severely impact the quality of care available to AHCCCS enrollees.
Limited Networks and Reduced Access: The Human Cost
Concerns are also mounting about the adequacy of ACH’s provider network, especially in rural areas where healthcare options are already scarce. A narrower network could restrict patient choice and access to specialists, forcing patients to travel long distances or endure long wait times – challenges that disproportionately affect seniors and low-income residents.
The potential human cost of ACH’s growing dominance is stark. If providers can’t sustain their operations due to low reimbursement rates, they may reduce services offered to AHCCCS patients or even opt out of the program altogether, worsening the access gap for those most in need.
Calls for Transparency, Oversight, and Accountability
The rapid changes in Arizona’s healthcare landscape demand immediate transparency and increased oversight. As ACH consolidates its position in the AHCCCS market, public scrutiny of its practices is crucial.
Monitoring the quality of care provided to AHCCCS enrollees and ensuring reimbursement rates are sufficient to maintain provider viability are necessary steps to protect Arizona’s most vulnerable populations. Strong patient advocacy is also needed to ensure the voices of those most affected by these changes are heard.
Despite multiple attempts to contact Kenneth W. Yergey of Arizona Complete Health, the company has remained unresponsive, deepening concerns about its practices and their potential impact on Arizona’s healthcare system.
Conclusion
The pause in the ALTCS-EPD member transition and the exit of major insurers highlight the precarious state of Arizona’s healthcare system. This situation demands immediate attention from policymakers and regulators to ensure that the future of AHCCCS prioritizes patient care over profit margins.
As Arizona’s healthcare landscape reaches a critical juncture, the decisions made in the coming weeks will have lasting consequences for the state’s most vulnerable residents. Skilled Care Journal will continue to monitor this developing story and provide updates as new information becomes available.