State delays enrollment for low-income health plans - Hawaii News Now - KGMB and KHNL

State delays enrollment for low-income health plans, costing taxpayers more money

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HONOLULU (HawaiiNewsNow) -

The state Department of Human Services has postponed open enrollment for 250,000 low-income people in the QUEST medical coverage program for a second time, a move that will cost taxpayers tens of thousands of dollars.

TV commercials have been running statewide this month by medical insurance companies trying to convince people to choose them as participants for the QUEST program, in which they have a choice among five health plans. 

In a news release Monday, the state gave two reasons for canceling and rescheduling the open enrollment period until June 17 through 28. The last day of enrollment was supposed to be May 15. 

First, DHS said marketing by certain health insurance plans -- which the state today would not identify -- failed to comply with their state contracts.

Non compliance can include inaccurate statements, cold call marketing or failing to get DHS to approve all advertising materials, a DHS spokeswoman said. 

But she would not detail what companies had failed to comply and what the violations were.  

The plans, which include Aloha Care, HMSA, United Health and Ohana Health, have bought television and radio commercials, sent out mailers and purchased newspaper ads hoping to convince Quest members to choose them. 

So the chance to change insurance companies for in the low-income QUEST program has been delayed until late next month. 

A DHS spokesman said Hawaii News Now would have to wait until Tuesday to find out how much the mailing of each packet to more than 100,000 households has cost the state.  This will be the third such mailing, which Hawaii News Now estimates costs state taxpayers $40,000 for postage alone, not counting envelopes and printed material. 

Second, DHS said there has bee "confusion" over which QUEST plans will be accepted by Waianae's only hospital. But this is all happening after sources said thousands of Waianae Coast Comprehensive Health Center patients left HMSA for other health plans because the two sides couldn't agree on a contract that expires July 1. A DHS spokeswoman could not provide an estimate Monday of the number of QUEST patients who'd left HMSA so far this month.

"We just want to be recognized by all the plans, and the state as well, that what we do is treat a unique population," said Dr. Vija Seghal, a pediatrician and chief quality officer at Waianae Coast Comprehensive Health Center.  "And we may need to be risk-adjusted for the social determinants: the high poverty, the low education, the high crime." 

The Waianae facility had renegotiated contracts with three other medical plans but hasn't been able to reach an agreement with HMSA since February of last year , because the hospital officials said HMSA didn't want to share savings with Waianae, if certain medical care goals were met. 

"If providers are able to make a difference in the process or the outcome of care, then the saving from the system will be returned to the providers," said the hospital's Chief Financial Officer, James Chen.  

HMSA also did not want to help pay for electronic records improvements at Waianae or open its financial books so the hospital could see how much savings occurred, hospital officials said. 

Waianae sent flyers to its 7,500 HMSA-covered QUEST patients saying their HMSA contracts would expire July 1, and as a result, thousands of people began signing up for other plans to get health coverage for visits there.


Last Friday, the two entities reached a verbal agreement in which HMSA agreed to continue covering visits to Waianae past the July 1 contract expiration.   

"As of this week, HMSA and the Waianae Coast Comprehensive Health Center have resumed negotiations and are committed to providing continuity of care to HMSA QUEST members," according to a joint statement from Elisa Yadao, HMSA's senior vice president, consumer experience and Rich Bettini, president and CEO of the hospital. 

Daryl Huff, senior director of Community Relations for AlohaCare, another health plan, released a statement that said, "AlohaCare respects and accepts what was clearly a very difficult decision by the QUEST administration." 

"We have been working very hard in the Leeward Coast to reassure the community that AlohaCare is ready and able to take great care of them if they decided to change plans and join our other 11,000 members in the area," Huff said.   

After HMSA, AlohaCare covers the second highest number of Quest patients at Waianae Coast Comprehensive Health Center, hospital officials said.   

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