Medicaid Plans Dropping Benefits Keystone Mercy And Hma Will No Longer Offer Eyeglasses And Dental Care For Some Members.

Posted: February 18, 1999

In a move state officials blame on financial pressures, two of the four Medicaid managed-care plans in Southeastern Pennsylvania are dropping benefits that they once used to lure clients: eyeglasses and dental care.

The cutback occurred Jan. 1 at Keystone Mercy Health Plan, whose 225,000 members make it the largest plan in the Health Choices program. Similar changes will take place March 1 for the 71,000 members of Healthcare Management Alternatives (HMA).

Both plans are dropping coverage of eyeglasses or contact lenses for anyone 21 or older, except for members with cataracts or aphakia, a post-cataract-surgery condition. And both will no longer pay for dental exams or teeth cleanings for some adult members who formerly qualified.

State officials said they were powerless to stop the cutbacks, because the services went beyond those required by federal or state Medicaid laws. The two plans did not drop adult dental coverage for their neediest clients, including the elderly, blind and disabled, because that coverage is mandatory.

``We're disappointed, but we do understand,'' said Christine M. Bowser, director of managed-care operations for the Department of Public Welfare.

``That is more than we were ever able to provide,'' Bowser said of the dental and eyeglass benefits. ``Given the current marketplace pressures, some of the plans had to make those decisions.''

Advocates for Medicaid recipients criticized the cutbacks.

``It certainly is disturbing that they feel compelled to cut back on these benefits,'' said Richard P. Weishaupt, a lawyer at Community Legal Services.

Weishaupt said it was especially frustrating that the cutbacks came at the height of the state's welfare-to-work initiative. People who can't see well will have a harder time finding and keeping jobs, he said.

``If they just try to go with glasses from three years ago, they run the risk that they're not going to be as efficient as they could be,'' Weishaupt said.

Not all the plans are cutting back.

Health Partners, which has about 104,000 members and is the only nonprofit among the four plans, will continue to cover eyeglasses and dental care, spokeswoman Deborah Tortu said.

``We're not changing any of those benefits,'' because Health Partners believes that having access to those services ``is important to our adult members,'' she said. She said Health Partners, which is owned by seven area hospitals or hospital systems, would be pleased to get new members as a result.

The fourth plan, HRM Health Plans (formerly Oxford), also plans no cutbacks, though it does not cover glasses or contacts for adult members except those with particular conditions.

``We have no intention of changing the benefits,'' said Keith Mock, vice president and general manager for HRM Health Plans (Pa.).

Officials at HMA and Keystone defended the cutbacks.

``It's a benefit that was not part of the benefit package that was mandated by the state,'' said Steven J. Matthews, a spokesman for AmeriChoice Corp., the parent company of HMA. ``It's a benefit that other companies serving the population have not been offering. And it was a benefit that we had been providing at our own expense. It was not part of the rate we received from the state.''

Matthews said that the dental cutback would affect about 6,000 of HMA's 71,000 members, and that the eyeglasses cutback would apply to ``somewhere over half our people.'' He said HMA ``will monitor what happens going forward March 1.''

Keystone officials would not say that the cutbacks were financially driven.

``I'm not able to answer that question,'' said Keystone spokesman Matthew Cabrey, when asked why the cuts were made. ``Our position has always been, and continues to be, that we cannot comment on the company's financial matters.''

Keystone is a joint venture owned by Mercy Health System and Keystone Health Plan East, the commercial health maintenance organization owned by Independence Blue Cross.

Bowser, the state managed-care official, said all four Medicaid plans were under financial pressure. She declined to provide details except to say they did better through the first three quarters of 1998 than they did in 1997, when all lost money. ``Three of the four are near breaking even,'' she said.

Matthews said HMA was doing better. ``We were in the black for 1998,'' he said.

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