December 2, 2019
As an integrated health system, MU Health Care works every day with public and private insurers to ensure that all the hospitals and valued providers throughout our system are in-network for each insurer’s members.
For almost 10 years, MU Health Care has had a contract with Home State Health (Home State), a Managed Care Organization that provides Medicaid coverage for many of our patients. Late this summer, Home State made the decision to terminate Capital Region Medical Center, Capital Region Physicians and related entities from its plan, which means they will no longer be considered in-network providers by Home State after Sept. 30, 2019.
We are surprised and deeply disappointed that Home State Health has excluded Capital Region Medical Center’s facilities and providers, an integral part of our health system, from being in network. Unfortunately, following further negotiations with Home State Health representatives and offering concessions to ensure we could provide in-network access for our patients throughout Jefferson City and the surrounding area, we were unable to reach a reasonable agreement.
Given this substantial change, MU Health Care’s contract with Home State Health has been terminated, effective Jan. 4, 2020.
MU Health Care patients currently receiving Medicaid coverage from Home State Health should call MO HealthNet Managed Care Enrollment Helpline at 1-800-348-6627 (Monday through Friday, 7 a.m. to 6 p.m.) to discuss options for doctors, hospitals and insurance plans that meet their needs.
MU Health Care physicians and facilities continue to be in-network providers for two other MO HealthNet Managed Care plans: Missouri Care and United Healthcare Community Plan.
Home State Health also has other participating providers in the mid-Missouri area. Members can call Home State Health member services at 855-694-4663 to find another in-network hospital and doctor. Members also can call 855-694-4663 if they are being treated for cancer or another condition requiring continued care to discuss their needs.
Now that the termination is in effect, we will continue to care for Home State Health patients already staying at a MU Health Care hospital, and we will honor the Home State Health contract until patients are appropriately discharged or transferred to in-network facilities. Similar agreements are in place for women in advanced stages of pregnancy receiving care through MU Health Care.
Our first concern is always the health of our patients and communities.
Frequently Asked Questions
Why did MU Health Care decide to terminate Home State Health?
Late this summer, during negotiations with Home State Health, Home State Health made the unexpected decision to terminate Capital Region Medical Center, Capital Region Physicians and related entities from its plan. This meant that Home State Health members would no longer be able to receive in network care at MU Health Care’s affiliates in Jefferson City after September 30, 2019.
We are deeply disappointed that Home State Health excluded an integral part of our health system from being in-network. Excluding certain facilities and providers from being in-network undermines the value that our integrated care delivery system provides to patients throughout mid-Missouri.
When will the termination occur?
We are deeply disappointed that Home State Health excluded an integral part of our health system from being in network. Given this substantial change, MU Health Care's contract with Home State Health has been terminated, effective Jan. 4, 2020.
Our first concern is always the health of our patients and communities. It would be our preference to reach a mutually agreeable resolution that includes both MU Health Care and Capital Region Medical Center facilities an provides for the well-being of the patients we collectively serve.
Who will be most affected by this termination?
This contractual change will affect patients who are currently members covered by Home State Health and receiving care from MU Health Care and physicians throughout our network.
This change only affects patients who are members of the Home State Health Medicaid managed care plan. Patients who are members of the other two MO HealthNet Managed Care plans – Missouri Care and United Healthcare Community Plan – are not affected and continue to have access to MU Health Care physicians and facilities through their plans.
Which MU Health facilities are affected by the termination? How does this termination affect the ability for patients to receive care at MU Health Care facilities (including CRMC)?
The MU Health Care system operates as an integrated health system. Excluding some of our facilities and providers from being in network undermines the value that our integrated care delivery system provides. Unfortunately, this contractual change means that MU Health Care facilities and physicians are no longer be considered in network providers for members covered by Home State Health.
Who should those affected by this decision call to help them find new doctors and hospitals to provide their care?
Patients can contact MO HealthNet Managed Care Enrollment Helpline at 1-800-348-6627 to discuss their options. MU Health Care still participates in the following MO HealthNet Managed Care plans: Missouri Care and United Healthcare Community Plan.
Home State Health also has other participating providers in the mid-Missouri area. Members can call Home State Health member services at 855-694-4663 to find another in-network hospital and doctor. Members also can call 855-694-4663 if they are being treated for cancer or another condition requiring continued care to discuss their needs.
How will I know if my doctor will be in network after the termination is complete?
Home State Health members should call member services at 855-694-4663 to discuss options for in network hospitals and doctors.
If I am admitted to a MU Health Care hospital and am still under inpatient care when the termination takes effect? Will I be subject to non-network rates?
Our top priority is the health of our patients and communities. We will honor the Home State Health contract until patients are appropriately discharged or transferred to an in network facility. Similar agreements are in place for women in advanced stages of pregnancy receiving care through MU Health Care.
If I need emergency care and a MU Health Care facility is the closest hospital or an ambulance takes me there, what will happen once this termination takes effect?
MU Health Care will provide emergency care and work with Home State to transition the member’s care to an in network provider/facility when the patient’s condition has been stabilized.
If I am pregnant and seeing a MU Health Care physician/OB for my care, do I have to leave my doctor that I trust mid-pregnancy?
MU Health Care may be allowed to manage care for Home State Health members who are current patients in their second or third trimester of pregnancy or postpartum. Members should call Home State Health member services at 855-694-4663 to discuss their individual situation and options.
How will this termination affect my health care costs? Will my premiums go up? What will my deductibles and co-pays be if I go to a MU Health Care facility or doctor?
Home State Health members covered under a Managed Medicaid plan do not incur any out-of-pocket costs for care. Home State Health members’ costs will not be impacted.
Why weren’t you able to reach agreement?
MU Health Care was surprised by Home State Health’s decision, since we agreed to concessions requested by Home State Health. In very late stages of negotiations, Home State Health also requested MU Health Care make additional changes involving other products. The terms were unacceptable, but Home State Health insisted on these additional conditions and terminated Capital Region Medical Center and Capital Region Physicians when the health system would not agree.
Would MU Health be willing to go back to the table to renegotiate?
Absolutely. We are deeply disappointed that Home State Health excluded an integral part of our health system from its managed Medicaid network. It would be our preference to reach a mutually agreeable resolution that includes both MU Health Care and Capital Region facilities and providers for the well-being of the patients we collectively serve.