County to cancel long-term health plan - East Valley Tribune: News

County to cancel long-term health plan

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Posted: Thursday, June 9, 2005 10:29 am | Updated: 8:09 am, Fri Oct 7, 2011.

A health plan that has helped thousands of Maricopa County’s most vulnerable residents for nearly 16 years will end Sept. 30.

The Maricopa County Board of Supervisors has decided to dissolve the Maricopa Long Term Care Plan. More than 6,200 members — most of them seniors, disabled or mentally ill — will need to move to two other long-term care plans, Evercare Select or Mercy Care, said David Smith, the county’s administrative officer.

About 140 employees will lose their positions with the county health plan.

The closure comes after the Maricopa Special Health Care District Board of Directors, elected by voters last November to run the county’s health system, refused this week to take over the plan, which is projected to lose about $16 million this year.

"The losses calculated by the district and the county could put the entire system at risk if we allowed that (health plan) to go on," said Dr. James Kennedy, the district’s interim chief executive officer. "That’s something the district cannot tolerate."

Nursing home leaders, however, are concerned that loss of the plan will mean less competition in long-term care and disrupted services to members.

"We’re deeply concerned about the demise of this plan," said Kathleen Collins Pagels, executive director of the Arizona Health Care Association, which represents nursing homes and assisted living facilities. "We believe that this plan has provided important leadership in serving the most poor and vulnerable elderly."

State and county officials, however, said they will work to ensure members continue to receive care, possibly from the same doctors nurses and caseworkers. In some cases, home health care workers have become like family to patients, authorities said.

The special health care district has been struggling financially since it took over this year the Maricopa Integrated Health System, which includes Maricopa Medical Center in Phoenix and several community clinics.

On Wednesday, the county Board of Supervisors approved a financial assistance package for the district worth up to $17.4 million.

The package includes restructured loans, forgiven debts, payments for correctional health services and $6.4 million for a performance bond the district needs to take over the Maricopa Health Plan.

The district plans to increase enrollment in the Maricopa Health Plan, a Medicaid plan with about 37,000 members.

"The kind of patients who are in that plan are essential for us," said Kennedy. "They’re a major part of our business."

Many patients in the Maricopa Long Term Care Plan are costly because they require a higher level of medical care, he said.

The health plan has had profitable years, especially when the county held a monopoly on long-term care services. But losses have mounted as new, healthier patients were lured to the two competing plans, leaving the sickest patients under the county’s care, said Kennedy. State reimbursement is not high enough to cover the cost of their care, he said.

Frank Lopez, a spokesman for the Arizona Health Care Cost Containment System, said they will be working with the Evercare Select and Mercy Care plans to transition patients from the Maricopa Long Term Care Plan, which has been in business since 1989.

"It was one of the old ones," he said. "We had a good partnership with them over the years, but finances change."

The health plan was one of several at the county that fell victim to past problems with a computer billing system, which left providers unpaid and the county unsure how much money was owed. The county health system, under previous management, also incorrectly projected costs to the health plans, digging them deeper into a financial hole.

When the special health care district was approved by voters to take over the county’s health care delivery system, the county kept the health plans to try to restore them to financial health.

The county has since closed its Maricopa Senior Select Plan for financial reasons. The remaining two health plans were offered to the district.

"It’s an opportunity for someone else," Smith said. "There’s nothing that requires us to be in the business and no justification to subsidize those (losses) by taxpayers."

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