INDIANAPOLIS — Indiana's Family and Social Services Administration announced it will cancel MDwise's Medicaid contract a year early, citing quality concerns, a decision the nonprofit insurer says could be devastating for its business and disruptive for Medicaid recipients.
MDwise, which the company says has held a Medicaid contract with the state for 30 years, currently provides care for more than 300,000 Hoosiers. The state requires three Medicaid health plans for recipients; MDwise has been a fourth option and the only nonprofit offering plans to Medicaid members.
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FSSA officials say the termination is based on the agency’s review.
"One of the things that the Braun administration did when they first came in was do a thorough examination, really, of all our Medicaid spending, specifically in this instance, was our managed care entities. And what we found was that MDwise had the lowest quality scores consistently and the highest cost,” Marcus Barlow, the deputy chief of staff for FSSA, said.
MDwise said it sent several pages of documents describing efforts to work with FSSA to maintain its contract through 2026. The company warned the move could create interruptions in care, a concern echoed by Medicaid patient advocates.
"There is just a lot of anxiety that this is going to lead to further disruptions to care,” Tracey Hutchings-Goetz, the health justice community organizer at Hoosier Action Coalition, said.
FSSA officials disputed that patients would lose continuity of care.
"They will receive a letter from us letting them know what their options are in the current open enrollment,” Barlow said. “But even if they decided to do nothing at all, they will be auto-enrolled to a plan nearly identical to the plan that they have.”
Recipients who do not like the plan they are auto-enrolled in will have 90 days after auto-enrollment to choose another plan. Advocates, however, worry some Medicaid recipients may have to change their care providers — especially because the carriers now managing Medicaid health plans are for-profit entities.
"I have a lot of skepticism about the ability of these other insurance companies to meet people's needs instead of maximizing shareholder profit,” Hutchings-Goetz said.
FSSA says the decision will save taxpayer dollars. Mitch Roob, the agency’s secretary, said the review found MDwise to be the most expensive and the lowest-quality among Indiana’s four plans.
The Hoosier Action Coalition urged Medicaid recipients with questions to contact their local statehouse lawmakers and said it has resources on its website to help navigate the changes.
