ForeverCare Drops Out of Medicaid Organized Care Model

News

LITTLE ROCK, Ark. – A company that offers services to high-needs Medicaid beneficiaries wants to partially stop doing business in Arkansas.

ForeverCare told its members Wednesday in an email that it will pull out of an organized care program operated by the Arkansas Department of Human Services (DHS).

“I apologize some of you may be finding out about our decision not to proceed with Phase II of the PASSE program this morning from anyone but me,” wrote Mike McCabe, the plan president. “Over the last two years we have attempted to build a health plan focused on members care and providing the best of everything for those in Arkansas we serve. In the end, the decision we made was based on what is best for the members.” 

A state law passed in 2017 created Provider-led Arkansas Shared Savings Entities, known as PASSEs, that operate like managed care companies. Four companies are part of the program that serves a total of more than 40,000 Arkansans with significant behavioral health issues or developmental or intellectual disabilities.

Phase I of the program, which began in Feb. 2018, provided care coordination. ForeverCare dropped out of Phase II Wednesday, which would also make the PASSEs responsible for paying for members’ Medicaid services. 

McCabe continued in his email, “Despite our best efforts we do not have the systems in place to assure members would be cared for in the way they deserve. In addition, the risks posed by the continuing questions around the program are too great for us to move forward at this time.”

“I believe we have three PASSEs that didn’t have the same thoughts on this,” said Paula Stone, the deputy director of the Division of Medical Services for DHS. “We meet with passes weekly, actually daily at this point. We had a really large meeting with the passes to address any outstanding questions or concerns they had.” 

Stone said ForeverCare’s 7,600 beneficiaries will soon get a notice of their reassignment to one of the three remaining PASSEs well before the Phase II start date of March 1. 

DHS pushed back the implementation of Phase II from Jan. 1 to March 1 “to allow systems to be tested, ensure that the billing systems are functioning seamlessly to allow timely payments to providers and allow more time for the training and enrolling of even more providers to the PASSE networks.”

In an email to the DHS director and others involved in the program explaining his company’s withdrawal, McCabe wrote ForeverCare “reached this decision with much reluctance in light of the March 1, 2019 implementation date.” 

McCabe continued, “As we have discussed, in addition to the fact that ForeverCare’s internal requirements dictate that it cannot enter into the Phase II Agreement unless the state date of Phase II is moved to July 1, 2019, we believe there are also program operational issues which need to be resolved before DHS implements Phase II.” 

McCabe wrote the company could still be involved if DHS pushed back the deadline or delayed ForeverCare’s participation in full risk until July 1. 

“I think the reason ForeverCare has elected to walk away is because they see what’s coming forward on March 1,” said Loretta Cochran, a ForeverCare member. “They know the risk of the gaps that are still open, and they’re not going to be a willing party to hurting their clients. I appreciate them being honest. The other three, I think, are sticking their heads in the sand.” 

Cochran, who is the guardian of a ForeverCare beneficiary, worries payments will not work correctly for smaller, more rural providers and beneficiaries will lose services.

“I won’t be here forever,” she said. “I have to have a system that I know is going to take care of and close that gap in support and leadership. If ForeverCare leaves and we don’t get these problems fixed before we cut over, I don’t know if we’re going to have that. In fact, I fully doubt that we will have any kind of security like that.” 

Stone said DHS does not plan on extending the deadline, confident everything will be in place by March 1. 

“We feel like we have a good plan in place where we’ve spent the morning making sure it will go smoothly for all of those beneficiaries,” she said. 

Once reassigned to one of the three remaining PASSEs, former ForeverCare beneficiaries will have 90 days to switch.  

Beneficiaries can find more information by visiting the PASSE website or calling the PASSE ombudsman at 501-320-6006.

Copyright 2019 Nexstar Broadcasting, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

Don't Miss

More Don't Miss