BMC HealthNet opens New Hampshire office as Well Sense Health Plan

By Chelsea Conaboy, Globe Staff

Boston Medical Center HealthNet Plan has named its new arm to the north. The Medicaid plan will operate in New Hampshire as Well Sense Health Plan, one of three insurers selected by health officials in that state to manage coverage for low-income and disabled residents.

The program is supposed to begin enrolling people for coverage in January, but the U.S. Centers for Medicare & Medicaid Services has not given approval for federal money to be used for managed care in New Hampshire. It’s not clear when the agency will issue its decision.

Lawmakers there voted last year to change the Medicaid program from a state-run system in which health care providers are paid for each test and treatment to one that is run by contracted health plans paid a designated fee for each patient.

The decision has faced intense scrutiny, particularly from those concerned about benefits for people with disabilities and mental illness. The approval process has been complicated by a lawsuit filed by hospitals alleging that the state used Medicaid money to balance the state budget and failed to properly notify them of reductions in their payments.

The state previously taxed hospitals to create state revenue that would be matched by federal dollars. Then the states would repay hospitals what they contributed. But in the last budget cycle, the state kept the federal money and preserved the tax, a situation one of the hospitals’ filings called “completely unsustainable.” Some hospitals have said the loss has caused them to cut back Medicaid services. Federal officials have raised questions about whether the cuts have hindered access to care for Medicaid enrollees.

The managed care health plans are now negotiating with hospitals and doctors to become part of their provider networks. But Steve Ahnen, president of the New Hampshire Hospital Association, said some are looking at that processing skeptically. The rates they are paid by Medicaid -- about 50 cents for every dollar in costs, he said -- are not likely to go up under the new program.

As a hospital, “if I join the network, what does that say? Does that say I’m ok with those rates?” Ahnen said. “I don’t see a quick resolution to any of this.” He said he thinks the January deadline for enrollment is “optimistic.”

Meanwhile, Well Sense is setting up its offices in Manchester and hiring up to 60 people who will serve as case managers and in other roles, said spokesman Harry Castleman.