PORTLAND, Ore. -- With 10 days to go before FamilyCare Health likely shuts down, employees worry about the Medicaid contractor’s most complex and vulnerable clients, according to new reporting from the Portland Business Journal.
In an exclusive report, the Business Journal outlined some of the concerns employees face as a shutdown looms.
Clients at risk include children and teens, some with suicidal tendencies, many of whom have experienced trauma. FamilyCare’s care coordinators have lined up with comprehensive treatment plans, encompassing therapists, nutritionists, primary care physicians, extended family and teachers. They visit their homes and schools regularly and get to know their families.
“The disruption in the FamilyCare coverage would mean massive chaos for these cases because folks are not covered on other plans, and all of their providers are very specialized in what they do and it's not easy to make a quick switch to someone else,” said Naomi Koide-Gasser, a licensed social worker at FamilyCare. “I’m desperately concerned about their readmission to the hospital and for their safety.”
Kevin Dickson, an intensive care coordinator at FamilyCare, said he has one young client who was discharged from the Unity Center for Behavioral Health without a transition plan because of questions about FamilyCare’s future. FamilyCare contracts with a crisis stabilization provider that said it can’t provide services to the girl “because of the current situation.”
Both FamilyCare and the Oregon Health Authority — which have been at an impasse for weeks over the coordinated care organization’s funding level — said Wednesday they are working to transition members to other CCOs with no disruptions in care. Portland-based FamilyCare serves about 120,000 people on the Oregon Health Plan, or Medicaid, in the tri-county area.
FamilyCare CEO Jeff Heatherington contends that OHA is paying it such low per-member-per-month rates that it would have a $95 million deficit next year, after running deficits for the previous three years. OHA is giving FamilyCare until noon Thursday to sign its contract, then it will start moving people to Health Share of Oregon, the largest CCO, and two smaller CCOs outside of Portland.
The problem is that many of FamilyCare’s clients are seen by providers who only contract with FamilyCare, so patients will be in a position of starting over with someone else. Clinics are likewise worried about the lost revenue.
OHA Director Patrick Allen said 80 percent of FamilyCare’s and Health Share’s provider networks overlap. If somebody is currently in active treatment, they are entitled to keep seeing their provider for 90 days, though at a lower “fee for service” rate, Allen said.
FamilyCare’s 322 employees are also worried about what their own futures hold.
“It’s devastating,” Koide-Gasser said. “I love my job here. We do really important work. We have colleagues who are fantastic and smart and dedicated people who are reeling at the thought that members we’ve treasured and treated with dignity are at a place where we can’t provide answers to them. It’s really hard.”
Many FamilyCare employees have a social work or nursing background and may be competing for the same jobs. Some are the sole breadwinners in their households, others on maternity leave. Some are older and scared of job hunting at this stage in their careers. Some wonder if they’ll soon be on Medicaid themselves.
None of the 10 employees who shared their worries on Wednesday wanted to point fingers for the current distress, either at OHA or Heatherington. He received a standing ovation at a Friday all-staff meeting when he broke the unhappy news of an impending shutdown, Dickson said.
“When it comes down to it, we need to make sure we’re working for the members who have our health plan,” said Karissa Smith, the manager of care management. “If my health plan told me you have us but after the first of the year you don’t, it’s very anxiety provoking. I can’t imagine the fear they have.”