You asked if there is an access issue for Charter Oak Health Plan (COHP) enrollees living in Windham County. You have a constituent who is having difficulty finding a primary care provider (PCP) in Putnam.

For this report we relied on the May 5 Monthly Cumulative Summary that the Department of Social Services (DSS) provides to the Medicaid Managed Care Council. Additionally, we checked the three COHP managed care organizations' (MCO) websites' provider directories. The MCOS rely on the providers to notify them when their panels are closed, but some may not always do so.

SUMMARY

DSS does not believe there is an access problem for COHP enrollees living in Windham County based on the same access standards that have been used for the HUSKY program (see OLR report 2008-R-0601 for an explanation of these standards). As of May 5, 2009, the three MCOs that serve COHP patients reported that, combined, they had 187 PCPs serving 304 program enrollees. The PCPs tended to be concentrated in Willimantic, Putnam, and Danielson. Additionally, DSS reported at the May 8, 2009 Medicaid Managed Care Council meeting that the plans were honoring 100% of the out-of-network requests from patients.

A search of the MCOs' websites indicate lower numbers of PCPs accepting new patients which, according to DSS, can be explained by providers not wishing to have their names in the directories or being part of a hospital-based network.

CHARTER OAK ACCESS IN WINDHAM COUNTY

Table 1 presents provider and enrollee data DSS compiled for the Medicaid Managed Care Council as of May 5, 2009. For all three MCOs, the provider figures combine HUSKY and Charter Oak as no MCOs serve Charter Oak enrollees exclusively in Windham County. Tables 2 through 4 show each of the three MCOS' PCPs accepting new patients, by town, as listed on the MCO's website. The MCOs have assured DSS that covered benefits are available either from network or out-of-network providers.

PCPs include family practice physicians, general practice physicians, internists, OB/GYNs, nurse practitioners, certified nurse midwives, advance practice registered nurse, and physician assistants. Since the MCOs almost exclusively serve both Charter Oak and HUSKY recipients, they include pediatricians on their PCP count. We exclude them in this report as Charter Oak generally serves only adults. (Some pediatricians may continue to serve young adults after they turn 18. )

According to DSS and the officials from the three MCOs, the main reason for the discrepancy in the number of PCPs between the report (Table 1) and the other tables is that some providers do not wish to have their names published in the directory even though they are serving existing Charter Oak patients and possibly still accepting new patients. Likewise, the MCOS' directories do not include hospital-based providers unless they have a stand alone office outside a hospital setting.

Table 1: Total COHP PCPs in Windham County as of May 5, 2009

Source: DSS

Tables 2, 3 and 4 provide provider information based on a search of the three MCOS' websites conducted in June 2009.

Table 2: AmeriChoice

Table 3: Aetna Better Health

Table 4: Community Health Network

[1] One of the PCP physician assistants is affiliated with Planned Parenthood and also sees patients in Willimantic.

RC: ts