HCA takes actions to ensure access to care for Apple Health (Medicaid) clients
Actions aim to ensure access during COVID-19 pandemic and beyond, particularly for behavioral health services
OLYMPIA--The Health Care Authority (HCA) is taking several steps to help ensure Apple Health (Medicaid) clients have access to high-quality physical and behavioral health services during the COVID-19 pandemic and beyond.
The pandemic has caused unprecedented strain on the health care system. Cancelled and postponed visits and procedures have impacted provider revenue, and it is expected there will be increased behavioral health (mental health and substance use disorder) needs as a result of the pandemic.
“The steps we are taking are meant to support health care provider viability so we sustain access to care for Apple Health clients, particularly behavioral health care,” said HCA State Medicaid Director MaryAnne Lindeblad. “This pandemic has posed exceptional challenges to providers. Through our actions, we will work with our five contracted managed care plans to ensure resources are deployed most strategically to sustain strong physical and behavioral health provider networks during these difficult times.”
Through Apple Health, HCA purchases care for more than 1.8 million Washington residents; 87 percent of Apple Health clients are enrolled in managed care. HCA's five managed care plans contract with health care providers and manage physical and behavioral health care for clients.
The actions HCA is taking include:
- Eliminating some verification requirements so people already enrolled in Apple Health can stay on their coverage. (Individuals can go to https://www.wahealthplanfinder.org/ to learn how to apply.)
- Quickly shifting to telehealth and bolstering primary care to adjust to the new COVID-19 realities of the need for greater self-care, prevention and use of technology. HCA now pays for telehealth services at the same amount as in-person services, and has provided comprehensive guidance for providers to help them use telehealth. HCA also has provided needed telehealth technology for providers and clients, including cell phones, laptops and telehealth licenses.
- Requiring the managed care plans to assist behavioral health providers who are in immediate danger of closing due to financial distress. This ensures provider viability now and into the future, especially as experts predict a considerable growth of people seeking behavioral health care later this year. HCA is working with the federal government to explore options for other providers.
- Issuing a request for proposals (RFP) to allow our state’s current managed care plans to expand to areas of the state in which they are not currently active if they have demonstrated successful performance in other regions.
- Amending state rules on an emergency basis to:
- Provide the basis for the RFP and potential future action by clarifying when HCA can adjust the number of its managed care plans, either overall or region-by-region, chiefly based on performance.
- Distribute new Apple Health managed care clients more evenly among the five plans in response to increased unemployment and need for health coverage. This includes discontinuing auto-assignment of new clients to any plan that has a statewide market share of greater than 40 percent, with clients still able to choose any plan they want in the region.
- Focusing on a number of other short-term and long-term strategies to ensure MCOs perform well. These strategies include additional requirements related to provider network adequacy, monitoring of patient access to services, and use of contract incentives or penalties.
About managed care
Managed care has greatly improved access to care and brings the fundamental values of care coordination, patient-focused enhancements and cost controls for the state because the insurers take on the annualized medical risks (the plans bear the risk of unexpected COVID-19 expenses, for example). These actions will ensure our high client satisfaction scores remain. The annual Medicaid client survey has reflected an increasing trend over the last 12 years in client satisfaction. In 2019:
86 percent of clients said it was easy to get services through Apple Health
90 percent of clients said they were able to get Apple Health services as quickly as they needed
- 93 percent of clients felt that the providers’ offices were open at times that were good for them.
Managed care is also especially well-suited to ensure higher performance with regard to integrating physical and behavioral health care. Washington is a leading state in the nation to integrate care.
“With these actions today, HCA is building on our historic successes,” Lindeblad said. “COVID 19 has hit us hard, but we will come out of this, and we must take additional measures to ensure our health care system remains viable.”