Cleveland Clinic, Ohio's Largest Medicaid Managed Care Plan May Part Ways

Another showdown is looming between a leading academic medical center and a payer it seemingly can’t live without, and once again it’s about Medicaid.

This time the 2 sides are Cleveland Clinic, which today was making news after performing its first full face transplant, and CareSource, a nonprofit health insurer that covers members in 4 states.

This week, the insurer, which offers the largest Medicaid managed care plan in Ohio, will send members required notices that their contact could end September 1, 2017, as required by the Ohio Department of Medicaid. The planned notices were reported by the Cleveland Plain Dealer.

“Regrettably, we recently received notice from CareSource that they may terminate our relationship,” the Clinic said in a statement released to the Plain Dealer. “In the event the relationship ends, patients may need another Medicaid plan to access Cleveland Clinic. We will work with CareSource to provide continuity of care for those patients.”

No details have been offered for pthe otential split, but these kinds of disputes between major academic medical centers and insurers over Medicaid rates have become increasingly common. Earlier this month, the Minnesota attorney general had to broker an agreement between the state’s largest pediatric health system, Children’s Minnesota, and Blue Cross Blue Shield of Minnesota, when the insurer tried to negotiate lower rates, and the health system refused.

When deals cannot be reached, academic health systems may find themselves left out of narrow networks and insurers look to find savings; health systems in urban areas or those that serve high numbers of complex cases are often in fewer networks, according to research by the Robert Wood Johnson Foundation.

If a deal between Cleveland Clinic and CareSource can’t be reached, patients who want to use the Clinic would have to 1 of 3 other Medicaid managed care plans accepted there. Or, patients could stay with CareSource and use other health systems in the Cleveland area.