A recent change in health care coverage has shifted nearly 96,000 Medicaid recipients in Lane County from PacificSource Community Solutions to Trillium Community Health Plan. This transition, which took place on February 1, affects about one in four residents in the area.
Trillium is now the only Coordinated Care Organization (CCO) in Lane County. CCOs work with the Oregon Health Authority to manage health care for members of the Oregon Health Plan, Oregon’s Medicaid program.
The change comes after PacificSource decided not to renew its contract, citing financial concerns. They stated that keeping the Lane County contract would hinder their operations in other regions. This has raised questions about whether Trillium can effectively handle the larger Medicaid population. Before this transition, they served around 30,000 members.
Experts emphasize the importance of seamless transitions in health care to avoid gaps in services. According to a study from the Oregon Health Authority, maintaining continuity of care is crucial for patient outcomes, especially in communities with high needs.
Trillium has assured members that benefits will remain unchanged. However, access to providers may vary. Some individuals may need to find new doctors if their current ones are not in Trillium’s network. About 15,000 to 25,000 former PacificSource members may be affected, with 9,600 having primary care providers outside the new network.
To help with the transition, Trillium is offering a “transition of care” program. This allows members to continue seeing their previous providers for 30, 60, or even 90 days, depending on individual needs. Experts recommend that patients utilize this period to establish care within the new network to avoid disruption in services.
Trillium is actively expanding its network. They plan to add an additional 275 behavioral health providers to ensure that mental health services are accessible to all members. As of now, the insurer is maintaining an online database for members to check which providers are in-network.
Although dental and pharmacy access remains consistent, there might be changes in prescription drug coverage. Trillium’s formulary may differ slightly from PacificSource, which means some medications could require changes. They have stated that their pharmacists will work closely with providers to ensure continuity of necessary medications.
Moreover, Trillium has ramped up its workforce to handle the increased demand, hiring some staff previously laid off by PacificSource. This proactive approach includes testing systems for claims and authorizations to minimize potential issues during this transition.
For responsive support, Trillium has established a dedicated service line for members to address any concerns about their care during this shift.
Understanding these changes can help Medicaid recipients navigate their health care better and ensure they maintain the support they need. For detailed information, the Oregon Health Authority provides resources on the transition here.
Source link
free
