WARREN — The Ohio Department of Medicaid has been asked by Bon Secours Mercy Health to step into a contract dispute between it and Anthem Blue Cross Blue Shield as the termination date for a transition period looms.

The health care provider Tuesday announced it requested Medicaid reassign all 50,000 Anthem-managed Medicaid beneficiaries who have gotten care at Mercy Health hospitals and by its doctors within the past year.

The request is among four made to the state department ahead of Mercy Health’s deadline on Monday to terminate the contract with Anthem. After, Mercy Health would become out-of-network for Anthem’s managed Medicaid insurance enrollees.

Mercy Health also asked Medicaid to freeze Anthem’s enrollment, for a special open enrollment period, which would allow people to switch and for an investigation into Anthem’s “lack of network adequacy” in the Youngstown and Lima areas.

Mercy Health became out-of-network for Anthem’s managed Medicaid members in Ohio on July 1 after months of talks failed to produce a new agreement. The sides two days later, however, announced a transition period that expires Monday.

Mercy Health argues it needs higher rates because it has experienced inflationary, labor and supply cost increases.

Anthem, however, said Mercy Health’s desired rate is more than double the rate of hospital inflation and accused Mercy Health of trying to leverage higher rates from non-Medicaid members by terminating Medicaid members.

About 3,500 people in the Mahoning Valley are impacted.

STATE RESPONSE

In a letter dated Tuesday to Bon Secours Mercy Health Chief Operating Officer Don Kline, Ohio Department of Medicaid Director Maureen Corcoran states that the ODM values its partnership with the health care company and thought it would be fitting for the ODM to serve as “honest broker” in attempting “to attain a meaningful transition as the Anthem Ohio Medicaid relationship between Mercy Health and Anthem comes to a close.

“As an initial matter, ODM’s primary consideration is the care and well-being of the over 3.5 million Ohioans served by the Ohio Medicaid program. Thus, I and other members of my leadership team were pleased to hear you confirm more than once during our conversation that the current dispute between BSMH and Anthem is wholly unrelated to the Ohio Medicaid program or Anthem Ohio Medicaid. As we discussed during the call, BSMH and Anthem agreed to work together to develop communications to members that ODM, Anthem Ohio Medicaid and BSMH could use in interaction with members, and disseminate those communications and principles to staff at both BSMH and Anthem Ohio Medicaid. Unfortunately, this did not occur,” Corcoran’s letter states.

She also states that in a conversation with Kline on July 1, a 60- to 90-day transition period was discussed, so it came as a surprise that in subsequent communications, Mercy Health announced it would accept Medicaid members only through July 31 “and is entirely at odds with the arrangement ODM understood the parties to have reached.

“Ohio Medicaid is presently in the process of notifying all Ohio Medicaid members that the annual open enrollment is forthcoming in the month of November, during which any member can freely choose to enroll in any Ohio Medicaid plan. It is indeed unfortunate that Ohio Medicaid members find themselves in the position of having to make potentially urgent or otherwise significant health care decisions because of a disagreement between two established and committed health care organizations that have told us that they have these members’ best interests at heart. ODM will not use its members as an incentive to force a resolution to that commercial, non-Medicaid disagreement. I strongly encourage BSMH and Anthem to put their business dispute on another track and leave individuals served by Ohio Medicaid out of it going forward,” Corcoran’s letter concludes.

LATEST CLAIMS

Mercy Health on Tuesday claimed Anthem is misleading members by failing to update its provider directory to show the system is no longer in the managed Medicaid network.

Also, Mercy Health claimed it has gotten reports from patients that Anthem has “been inaccurately” telling patients they don’t need to change plans because Mercy Health remains contracted with Anthem, a news release from spokeswoman Kara Franz states.

“This misrepresentation demonstrates a pattern by Anthem to take actions aimed at maximizing profit at the expense of patients. Mercy Health’s current contracts with Anthem have not kept pace with the rising cost of labor, supplies and medications, undermining our ability to provide care now and into the future,” the release states.

The release also pointed out in Anthem’s latest earnings report, the company showed $5.5 billion in year-to-date operating income, an increase of more than 14 percent from the same period last year.

Anthem spokesman Jeff Blunt said because Mercy Health “has chosen to refuse” Anthem Medicaid coverage come Aug. 1, the insurance company is “helping Medicaid members transition elective care to one of the many high-quality health systems in our network.”

The company also is working with Mercy Health to help members who need continued care with an existing provider for some serious and complex conditions, Blunt said.

“Anthem’s care provider network meets or exceeds adequacy requirements in every location Mercy Health offers services and we are continually evaluating our network to ensure care availability for those we serve,” Blunt said.

Anthem earlier asked Mercy Health to rescind terminating the contract, honor it and negotiate a new agreement when the contract ends next year.

“They are needlessly disrupting care for thousands of vulnerable people as a negotiating tactic to force higher prices on people covered through their employers or the Affordable Care Act,” Blunt said.

Also, Blunt said all care providers on a list Mercy Health gave Anthem to be removed from its directory were removed as of July 1, however, the list “was inaccurate and out of date.

“We’ve been working as quickly as possible since then to correct that list and remove the remaining providers,” Blunt said.