Anthem Partnership Plan Covered Families and Children (CFC) State Contracts Will Not Be Renewed

The Bureau of Managed Health Care (BMHC) has notified the AMCNO that Anthem Blue Cross/Blue Shield (BC/BS) intends to end its provider agreement with the Ohio Medicaid Program and will no longer serve Medicaid consumers in the Covered Families and Children (CFC) managed care program effective March 31, 2008. Anthem will, however, continue to serve Aged, Blind and Disabled (ABD) Medicaid consumers without any interruption.

This change WILL IMPACT physicians and their Medicaid patients in Northeast Ohio region because at this point in time Anthem has 87,011 Medicaid consumers listed as members in this region. Other regions affected include the Central and Northwest regions of the state.

Plans are underway by the Ohio Department of Jobs and Family Services (ODJFS) to notify Anthem members to assist them in transitioning to new health plans in their region. ODJFS plans to send a notification letter to the 87,011 Northeast Ohio Anthem members on February 25, 2008, with a reminder letter to be sent out on March 10, 2008. The anticipated enrollment transition date is April 1, 2008. 

For members that do not make an affirmative choice of a new managed care plan, ODJFS will automatically assign them to the managed care plan (MCP) with the best overlap with their historic relationships with primary care providers. Any member who is dissatisfied with the auto-assignment to an MCP may switch within 90 days by contacting the Ohio Medicaid Managed Care Enrollment Center at 1-800-605-3040. Currently there are two other MCPs operating in the Northeast Ohio region that Anthem Medicaid consumers may choose from at this time CareSource and WellCare. 

Anthem has issued a news release indicating that continuity of care will be the responsibility of the receiving MCP. The new MCP and providers may contact the Anthem Partnership Plan for assistance with CFC Medicaid patients who require a continuity of care plan for qualifying conditions. Contacts may be made to the Anthem Utilization Management Department at 1-866-896-6580.

Anthem will continue to reimburse providers for eligible CFC Medicaid claims with dates of service up to and including midnight of March 31, 2008. Service dates beginning April 1, 2008 will be the financial responsibility of the members’ newly assigned MCP. 

If you have Medicaid patients in your practice that are currently enrolled in Anthem you may wish to review whether or not your practice is also contracted with one of the other MCPs still operating in the Northeast Ohio region. The AMCNO will continue to monitor this situation and provide any updates as necessary.