Columbia United Providers will once again have a direct contract with the Washington State Health Care Authority to manage Medicaid care for Clark County residents.
The new contract is effective Jan. 1 and comes more than two years after the state terminated CUP’s 18-year contract with the state during its last procurement of Medicaid plans.
“We are honored and excited that the HCA will be contracting with CUP directly in 2015,” said Karen Lee, Columbia United Providers’ president and chief executive officer. “This is the result of a tremendous amount of hard work from our staff, our providers and our legislative allies in Southwest Washington.”
The Health Care Authority announced in January 2012 that it would not renew its contracts with two Medicaid managed care providers in Clark County: Columbia United Providers, a Vancouver-based health insurance plan owned by PeaceHealth Southwest Medical Center and other local providers, and the Seattle-based nonprofit Community Health Plan of Washington. Instead, the state opted to contract with Molina Healthcare of Washington and Coordinated Care.
In late May 2012, the state announced the two new plans couldn’t establish the robust provider network required under the terms of the contracts. In response, Community Health Plan and Columbia United Providers joined forces and submitted a new proposal to the state that was approved in June 2012.
Under the deal, Community Health Plan held the Medicaid services contract with the state, and CUP, as a subcontractor, processed all claims and referrals for local providers.
“It’s reasonable to think that CUP would have closed down in 2012 when it lost its contract,” Lee said.
The collaboration with Community Health Plan of Washington prevented that from happening. But under the new, direct contract with the state, CUP will no longer have to split the premium from the state. That, Lee said, will help the company financially.
The two organizations currently manage the care for 53,000 Medicaid beneficiaries in Clark County. When the new contract goes into effect Jan. 1, those Medicaid clients will, in many cases, be automatically transferred from Community Health Plan to Columbia United Providers.
In addition to the direct Medicaid contract, CUP has been approved to sell three plans on the commercial health exchange, Washington Healthplanfinder. The expansion to the commercial market was a stipulation the state put in place before CUP could receive a direct Medicaid contract, Lee said.
“We’ve done that specifically to create a continuum of care for Medicaid beneficiaries as their income improves and they move from Medicaid to the exchange for their insurance coverage,” Lee said.
Columbia United Providers is also in the process of receiving accreditation from the National Committee for Quality Assurance, at the request of the state. That process will likely continue for another 18 months, Lee said.
“It’s been a lot of work over the last year,” she said.
