Gateway Health Plan is terminating its Medicaid contract with three local for-profit hospitals effective the end of the year.
Gateway said the move followed a year of failed contract negotiations with Florida-based Health Management Associates Inc., which operates Carlisle Regional Medical Center, Lancaster Regional Medical Center and Heart of Lancaster Regional Medical Center.
Gateway said it gave more than 30 days of notice of the change, as requested by the Pennsylvania Department of Public Works, and is working on options so members who are pregnant, postpartum or in current treatment plans "will be able to receive services from the nonparticipating providers until their treatment is complete."
Neither party provided specifics of the disagreement, but CRMC released a statement saying Gateway's contract renewal would have "decreased the rates to be paid to the hospitals substantially while hospital costs have continued to increase."
The statement continued, "While our hospital-affiliated physician groups are not part of this negotiation, Gateway requires physicians to admit to an 'in-network' facility. For this reason, Gateway may not allow these physician groups to continue to see patients who are members of their health plan."
CRMC is still in-network for AmeriHealth Mercy and United Healthcare Medicaid plans, it said, and its hospital-affiliated physician groups are in-network with AmeriHealth Mercy. CRMC said Gateway Medicaid members may switch managed health care plans at any time to ensure that their provider of choice is in-network, and that CRMC regrets any inconvenience the situation causes.
CRMC also noted that the termination will not affect members of Gateway Medicare.
“We are making every effort to get this issue resolved quickly,” said Bob Moore, market CEO for both HMA Lancaster hospitals. “It is going to require some compromise and good faith effort by Gateway. We are committed to doing our part.”