Anthem opts out of Nevada Medicaid

Anthem Blue Cross Blue Shield has notified the Health and Human Services Department the company is terminating services to Nevada Medicaid effective the end of this year.

Health Care Financing and Policy Administrator Charles Duarte said Anthem provides all HMO services including claims administration for Medicaid patients for a fixed monthly rate.

"They're assuming the risk of the incurred medical costs for those patients," he said. "The financial uncertainty involved in medical costs is made more certain by that per-member, per-month rate " for the state, at least."

Anthem received a 3.6 percent increase in those rates Jan. 1 but had requested the state increase its rate again. He said his office and Human Services Director Mike Willden have been negotiating with Anthem for some time but were unable to satisfy the company.

"One of the issues is the federal government requires us to pay them an actuarially sound rate so I can't just make something up. It has to be a rate that was determined to be appropriate."

Anthem provides services to Medicaid enrollees primarily in the Las Vegas and Reno urban areas. It serves some 40,600 of the more than 50,000 on Medicaid and 8,500 of the 27,500 children served by Nevada CheckUp.

He said federal law requires the state offer two managed care plans to provide consumers with a choice and he said his staff has already begun looking for a replacement plan.

"We are in the process of evaluating some other options to replace Anthem Blue Cross Blue Shield," he said. "There are options that may be, hopefully, budget neutral. Some might even save us money. It could cost us more, but I really can't determine that right now."

He said consumers won't be impacted by Anthem's decision to pull out, but the state could face financial stability problems with the program if they don't meet federal requirements for Medicaid managed care.

- Contact reporter Geoff Dornan at gdornan@nevadaappeal.com or 687-8750.