Update: As of Sept. 24, MDH says Kaiser Permanente has reached out to further continue negotiations with the health secretary.
The Maryland Department of Health is dropping Kaiser Permanente as one of its managed care organizations (MCOs) for Medicaid next year, WYPR has learned.
The unprecedented move will force about 109,000 residents to transition to different plans for health care.
“After some lengthy contract negotiations the Department of Health has elected not to enter into a contract with Kaiser and we are working to ensure a seamless transition of those enrollees to other health plans,” said Ryan Moran, MDH’s deputy secretary of healthcare finance.
The state is still renewing its contracts with eight other MCOs including Aetna Better Health, CareFirst Community Plan, Medstar Family Choice and others.
“New contract terms are part of the Moore-Miller Administration’s commitment to strengthen programs like Medicaid, now and into the future, to ensure that Maryland is healthier and a state where more people can work, grow, and thrive,” Moran said. “The changes, applicable to all MCOs, come after an extensive review of best practices and evidence that will both support better health outcomes for Marylanders and responsible stewardship of taxpayer dollars.”
Kaiser’s absence from Medicaid could have ripple effects, according to Gene Ransom, the CEO of the Maryland State Medical Society.
“It particularly is adverse for people in Prince George's and Montgomery County, where Kaiser has a very large footprint, as well as parts of Baltimore County,” Ransom said.
Kaiser uses an in-house care model, which means patients see physicians at Kaiser facilities. Ransom said the loss of more than 100,000 patients might make the company rethink how many facilities it wants to operate in Maryland, Ransom said. That, in turn, could have impacts on commercially-insured patients.
"We are committed to transparency and regulatory reporting compliance, and we are working with the Maryland Department of Health to address the department’s concerns and resolve this matter," said Betty Hwang, a Kaiser spokesperson.
MDH is imposing new requirements on its MCOs for 2025. It is not clear if those requirements had anything to do with the contract breakdown.
Those requirements include collecting data to improve standards of health equity and meeting national standards for equity.
MCOs must also meet certain staffing requirements to ensure quality and oversight and all MCOs must have 14 leadership positions including a health equity director.
Moran said the equity efforts will expand covered medical services to neighborhoods that may not have readily available resources. For instance, a company may contract with a new medical transportation company for an area that was previously not served.
Maryland Medicaid will also begin covering pre-release services for incarcerated youth.
