WYPR has uncovered that the Maryland Department of Health would drop Kaiser Permanente as one of its managed care organizations (MCOs) for Medicaid next year.
The extraordinary action will require approximately 109,000 residents to change their health-care plans.
“After some lengthy contract negotiations, the Department of Health has elected not to enter into a contract with Kaiser, and we are working to ensure a seamless transition of those enrollees to other health plans,” stated Ryan Moran, MDH’s deputy secretary of healthcare finance.
The state is still renewing contracts with eight additional managed care organizations, including Aetna Better Health, CareFirst Community Plan, MedStar Family Choice, and others.
“New contract terms are part of the Moore-Miller Administration’s commitment to strengthen programs like Medicaid, now and into the future, to ensure that Maryland is healthier and a state where more people can work, grow, and thrive,” Mr. Moran said. “The changes, applicable to all MCOs, come after an extensive review of best practices and evidence that will both support better health outcomes for Marylanders and responsible stewardship of taxpayer dollars.”
Kaiser’s withdrawal from Medicaid could have ramifications, according to Gene Ransom, CEO of the Maryland State Medical Society.
“It particularly is adverse for people in Prince George’s and Montgomery County, where Kaiser has a very large footprint, as well as parts of Baltimore County,” Ransom told me.
Kaiser follows an in-house care model, which means that patients see doctors at Kaiser facilities. Ransom said the loss of more than 100,000 patients may force the company to reconsider how many sites it wants to run in Maryland. This, in turn, could have implications for commercially insured patients.
“We are committed to transparency and regulatory reporting compliance, and we are working with the Maryland Department of Health to address the department’s concerns and resolve this matter,” according to Betty Hwang, a Kaiser spokesman.
MDH is implementing new restrictions for its MCOs in 2025. It is unclear whether these criteria had anything to do with the contract collapse.
These responsibilities include data collection to improve health equity standards as well as satisfying national equity standards.
MCOs must also meet certain staffing standards to maintain quality and oversight, with all MCOs requiring 14 leadership posts, including a health equity director.
Moran stated that the equality measures will extend insured medical treatments to neighborhoods that may not have readily available resources. For example, a corporation may enter into a contract with a new medical transportation provider to serve a previously unserved area.
Maryland Medicaid will also start supporting pre-release services for jailed youngsters.
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