Thousands of Lea County residents enrolled in Medicaid may soon not be able to access Lea Regional Medical Group and its physicians for non-emergencies.
LRMC alerted local Medicaid patients through a mailing it may not be able to use the hospital for non-emergencies after this month due to an impasse in contract negotiations with health insurers.
LRMC, the only hospital in Lea County that provides obstetric services such as labor and delivery, is encouraging local Medicaid patients to contact state lawmakers for help, although lawmakers say there’s not much they can do.
State Sen. Gay Kernan, R-Hobbs, said the potential for the situation getting worse is high as negotiations go forward.
“But I think at the end of the day I am hopeful and strongly encourage both sides to come together to reach an agreement for the benefit of these patients,” Kernan said. “I do care about the people that are going to be impacted.”
In a letter to sent to local Medicaid patients last week, LRMC said it must sign new contracts with three insurance companies that work with Centennial Care 2.0, the state’s Medicaid program.
LRMC said it has signed an agreement with Western Sky Community Care, but has not reached agreements with Presbyterian Health Plan or Blue Cross Blue Shield of New Mexico, which provide the lion’s share of Medicaid coverage in Lea County.
“Without Centennial Care 2.0 agreements with PHP and BCBSNM, our hospital and practices will not be in their network after March 2019, meaning your access to our providers will not be available for non-emergencies,” LRMC said in the bilingual letter. “While we are hopeful we can reach new agreements with PHP and BCBSNM, we may not be able to.”
LRMC encouraged patients to contact their state lawmakers by offering their contact information at the bottom of the letter.
“Let your elected officials know you need medical care close to home and work,” LRMC wrote. “You can email them so they know how this will be a problem for you and/or your children.”
LRMC listed email address for Kernan, state Sen. Gregg Fulfer, R-Jal, as well as state Reps. David Gallegos, R-Eunice, and Larry Scott, R-Hobbs.
The hospital offered ideas about what to include in communications with lawmakers, such as “I am covered by Centennial Care 2.0 and am asking for your help so I can get medical care near my home and job,” “My children need to be able to see the doctor,” “If Presbyterian Health Plan and Blue Cross Blue Shield of New Mexico do not have new agreements with Lea Regional Medical Center it will be hard for me to get to the doctor,” and “Please help my children and me get the are we need.”
About 39 percent of Lea County residents, a total of about 27,500 people, are enrolled in Medicaid, according to the New Mexico Department of Health.
Gallegos said LRMC CEO Timothy Thornell previously discussed the issue with lawmakers in Santa Fe. He said Thornell wanted local state lawmakers to arrange a meeting between LRMC and insurance providers.
“Because he was having a hard time getting them to meet with him,” Gallegos said. “I would consider it critical to us. It’s important that they at least get to be heard by the providers and they’ll find out why they’re not willing to pick up that cost or see if there’s any chance to negotiate it.”
Thornell and other LRMC officials did not respond to multiple requests for interviews.
Gallegos said there’s still time in the legislative session that ends March 16 for state lawmakers to address the issue.
“I left that with Gay Kernan because she’s our medical expert,” Gallegos said. “It is important statewide, for Lea County it would be real important, for us to be able to participate with Blue Cross and/or Presbyterian.”
Kernan said the impasse is about medical coverage reimbursements. She said the bulk of LRMC’s Medicaid patients are covered either by Presbyterian Health Plan or Blue Cross Blue Shield of New Mexico, and are therefore at risk of losing access to the hospital for non-emergency treatment.
“As a legislator that represents the people of Lea County, certainly we’re concerned about the lack of coverage if a contract cannot be reached between the parties,” Kernan said. “So that is a great concern to me that the network would not be complete.”
Kernan explained hospitals periodically reach reimbursement rate contracts with insurers.
“My understanding is that’s where the disagreement is, that (Community Health Systems) and the two insurance companies are unable to reach an agreement on what that reimbursement rate will be,” Ker-nan said.
Community Health Systems and its affiliates own, operate or lease 106 hospitals in 18 states, including LRMC in Hobbs, Eastern New Mexico Medical Center in Roswell, Carlsbad Medical Center, and Mountain-View Regional Medical Center in Las Cruces.
Kernan said Presbyterian Health Plan and Blue Cross Blue Shield of New Mexico had contracted with Community Health Systems for several years as part of Centennial Care 1.0. Molina Healthcare and UnitedHealthcare were also part of Centennial Care 1.0.
Centennial Care 2.0 is the second phase, Kernan said.
“So there were four originally,” Kernan said. “So when the Human Services Department began establishing the 2.0, they did not contract with Molina and they did not contract with United, so that left Blue Cross and Presbyterian and then they brought in a new insurance company called Western Sky. So some of the Medicaid recipients went into Western Sky, all of United participants, in Lea County or across the state, were purchased by Presbyterian. So Presbyterian has a huge percentage of Medicaid patients because they absorbed all the United patients.”
Kernan said she’s not allowed as a lawmaker to mediate in contract negotiations.
“However, my position is that I urge both parties to work diligently to resolve their issues,” she said. “I would encourage them to see if they can reach agreement with regard to reimbursement because that’s what this is about.”
Kernan said while health care contract negotiations hit roadblocks from time to time, it’s a very serious matter considering the reliance of local Medicaid recipients on LRMC.
“That is the only hospital that does (obstetrics and gynecology in Lea County),” she said. “There are several independent physicians, for instance, Dr. (Mukeshbhai) Patel, the cardiologist that houses out at Lea Regional. He’s got an office out there, but he is not an employed physician, so he would not be impacted by those negotiations. I think that’s important because he has a huge practice and I think it’s really important for people to understand that piece of it. So they’ll be covered because they negotiate with him directly and he is not impacted by the negotiations of the hospital.”
