The Vancouver Clinic’s announcement this week that it will not accept new Medicaid clients has left other local providers to wonder where the patients will go.
The Vancouver Clinic currently provides primary care for 36,000 Medicaid clients in Clark County — more than any other community provider — and its specialists serve not only Vancouver Clinic patients but those who receive primary care from other local clinics.
Vancouver Clinic officials said this week they will no longer accept new Medicaid clients for primary care or most specialty care and will, over the next three years, reduce the amount of Medicaid services they provide from 25 percent of their total business to 10 percent.
The county’s next-largest Medicaid provider, Sea Mar Community Health Centers, suspects it will feel the pressure as a result.
“It will definitely impact not just us, but anyone providing medical care for Medicaid patients,” said Lynnette Pickup, clinic manager for the Clark County Sea Mar clinic. “We anticipate that will put more strain on us. We will have to look at how we’re going to respond to that. It will be difficult.”
Sea Mar, The Vancouver Clinic and other local providers are still grappling with a surge of new Medicaid patients who enrolled in the program through the Medicaid expansion that changed eligibility requirements to allow more low-income adults to join the program.
Since October, the expansion added about 19,000 new Clark County adults to the Medicaid program, bringing the county’s total number of Medicaid clients up to an estimated 100,000 people.
As a result of the expansion, The Vancouver Clinic added about 5,000 new adult Medicaid clients. At the same time, the county’s two Sea Mar clinics have nearly doubled the number of Medicaid clients they’re seeing, from 10,500 to 20,900 clients.
“We are feeling the pressure of more people wanting to be seen, and we’re working constantly on meeting that demand,” Pickup said.
Shortage of specialists
But the bigger concern, particularly in light of The Vancouver Clinic’s announcement, is finding specialty care for local Medicaid clients, Pickup said.
“So many of the specialists are part of The Vancouver Clinic for the Clark County area,” she said. “We’re absorbing more patients and have fewer places to send them out.”
But that isn’t a new problem, Pickup said. Finding specialty care for Medicaid clients has long been a problem, she said.
At the Hudson’s Bay Medical Group, some patients are already sent to Longview or even Seattle for specialty care, said clinic administrator Fran Langan.
“The sad part is, all these patients have nowhere to go,” she said.
Vancouver-based Columbia United Providers manages the care for most local Medicaid clients through a contract with Community Health Plan of Washington. Columbia United Providers contracts with local medical offices to provide care for Medicaid clients.
CUP officials declined to comment on The Vancouver Clinic’s decision and whether CUP had enough contracted providers and specialists to care for all of its Medicaid clients.
As of Jan. 1, all new Clark County Medicaid managed care clients are assigned to Community Health Plan/CUP, unless they ask for a different managed care plan. Last month, state officials said the two organizations have enough local providers to care for the county’s entire Medicaid population, if necessary.
It’s unclear whether The Vancouver Clinic’s decision has changed that.
Vancouver Clinic officials cited a growing concern for the clinic’s financial stability as the primary reason for the changes regarding Medicaid clients. The current Medicaid reimbursement for an office visit covers only about 40 percent of costs, clinic officials said.
Sea Mar is a federally qualified health center and, as such, receives additional federal funding to provide health care services. The Sea Mar clinics are the only qualified health centers in Clark County.
The Medicaid reimbursement rates are disgraceful, Langan said, but she was disappointed to hear Vancouver Clinic officials claim other local providers aren’t sharing the burden.
The Hudson’s Bay Medical Group is a much smaller practice with just five primary care providers and 11,100 patients. However, about 6 percent of the clinic’s patients are Medicaid clients and another 25 percent are on Medicare, which also has reimbursement rates lower than those of commercial health plans.
“I just thought it was unfair,” Langan said. “We have been definitely carrying our fair share.”
Pickup said she too was disappointed to hear of The Vancouver Clinic’s decision.
“I think it’s unfortunate,” Pickup said. “I think we have a role to fill, and they have a role to fill. It would be nice to feel like we’re on the same team.”
