Eight months into a major health care transition, state agencies say former community fears were unfounded and children and families are satisfied with continued services.
Last December, the state shifted Medicaid users’ insurance from Magellan Health Inc. to five Healthy Louisiana plans –formerly known as the five Bayou health plans Aetna Better Health, Amerigroup Real Solutions, AmeriHealth Caritas, Louisiana Healthcare Connections and United Healthcare.
At the time, several community leaders and child welfare agencies voiced concern that the transition would mean children would slip through the cracks or experience gaps in their services.
Magellan Vice President Colleen Flanagan Johnson said her organization worked closely with the Louisiana Department of Health and the five Healthy Louisiana plans to ensure an orderly transition.
While families seemed to weather the transition well, providers experienced some “hiccups,” said Shelia Sterling, vice president and chief operating officer for the Greater Baton Rouge Chapter of Volunteers of America.
“For the providers, it’s been challenging to manage five plans because each plan wants something a little different,” Sterling said. “Delayed and denied payments appear to be the biggest challenge for most providers.”
Transitioning from Magellan
The transition away from Magellan affected an estimated 980,000 individuals receiving Medicaid in the state, including more than 1,700 children, according to Louisiana Department of Health data.
LDH spokeswoman Samantha Faulkner said the state’s initial challenge while bringing the new behavioral providers on board was to ensure that families and children didn’t experience service interruptions.
“Overall the integration went well. To our knowledge, there have been no significant loss, if any, of provider participation during the transition,” Faulkner wrote in an email.
Joshua Brett, spokesperson for AmeriHealth, confirmed his agency had worked closely with the state during the transition. He added that the integrated care model allowed the agency’s clients to have all of their needs managed out of AmeriHealth’s headquarters in Baton Rouge.
The transition also went smoothly for the Louisiana Department of Children and Family Services. Secretary Marketa Walters said the department chose to work with two plans in particular – Louisiana Healthcare Connections and Amerigroup Real Solutions.
“The move has been very positive. They have integrated health management, and that is complex,” Walters said. “Our children always have multiple needs.”
Walters said the biggest challenge for the department was educating staff, who had to learn to navigate the “newness” while also continuing to find placements for children.
Learning how to navigate five plans instead of one also proved inconvenient for Beth Salcedo, who runs the state’s only safe house for child victims of sex trafficking.
Magellan was “focused” and “systematized,” Salcedo said— whereas the Louisiana Health plans all require different codes and rules. But a bigger headache for Salcedo was waiting for reimbursement for the services she provided to her girls during the transition.
“The reimbursement processes are a mess. We are just now getting caught up with monies owed to us from January,” Salcedo said.
The Free Indeed Home in the Greater New Orleans area is the state’s only safe house for child victims of sex trafficking. (Photo: Henrietta Wildsmith/The Times)
Salcedo, who said she constantly struggles to find funding to keep the home’s doors open, had to draw on reserve funds to weather the transition. Rick Wheat, CEO of the Louisiana Methodist Children’s Home in Ruston, said his therapeutic group home also had to draw on reserve funds while waiting reimbursement.
“Anytime you have transitions, there are things that work well and things that don’t,” Wheat said. “Eight months in, we’re just starting to break even. We’re talking millions.”
Faulkner acknowledged the first six months of the transition involved some provider specific payment issues but added the managed care organizations had resolved many of the issues in a timely manner.
A continued lack of in-state resources
Stephanie Patrick, director of policy and planning at the Advocacy Center in New Orleans, said her organization had to help only a few families who experienced problems accessing services during the transition.
What her organization remains most concerned about, Patrick said, is the continued lack of crisis stabilization services in the state.
Crisis stabilization providers offer short-term care – generally less than seven days – for children in the midst of a severe psychiatric or substance use crisis and is an alternative to hospitalization. The state currently has no such providers.
“In the past 18 months, conditions haven’t improved,” Patrick said. “Children in the [Coordinated Systems of Care] program are at high risk for placement in a hospital, psychiatric residential treatment facility or other institution, and the lack of these core services only places them at higher risk.”
Faulkner said the department continues to recruit crisis stabilization providers, as well as additional therapeutic group homes, to expand the number of licensed health professionals in under-served areas of the state.
Curtis Eberts and David Sikes, executive directors for wraparound services in different parts of north Louisiana, both said that while crisis stabilization services remain una