States plan to ensure access to top cancer care providers

Kara Hartnett writes for Modern Healthcare on two states that plan to ensure access to top cancer providers for their low-income residents. To date, Medicaid and state health insurance exchange plans, not unlike a lot of Medicare Advantage plans, do not include National Cancer Institute providers in their networks. New York and California are putting an end to this health inequity.

Under new laws in both New York and California, insurance companies will have to work out a payment arrangement with National Cancer Institute Cancer Centers. The New York law went into effect in April. The California law is expected to go into effect in January 2023.

What does this mean? If you live in New York City and your insurance is through Medicaid or a NY state health insurance exchange plan, you will be covered for care from Memorial Sloan-Kettering Cancer Center.

These two state laws will help promote health equity for people with low incomes, people of color, and other people who otherwise would not have access to care from a cancer center of excellence. And, they make sense. Why should insurers be allowed to contract with low-value providers and not be required to contract with high-value providers?

Insurers should not be allowed to keep enrollees from getting their care from centers of excellence. To date, Medicare Advantage plans have had free rein to restrict access to these centers for their enrollees. It’s how they save money–while likely jeopardizing the health and well-being of their enrollees.

The federal government should step in to stop insurers from designing their own provider networks, particularly in Medicare and Medicaid, where the government negotiates provider rates. Networks make no sense in Medicare Advantage, as Medicare Advantage plans can piggyback off of traditional Medicare provider rates. They don’t need a network to bring down provider rates. The only purpose the network serves is to keep people with complex conditions from getting care from the specialists they need to see.

What’s worse for people in Medicare Advantage plans is that the federal government has no way to ensure that network providers are adequate to meet enrollee needs. While there are Medicare Advantage rules in place regarding time and distance, the rules do not include provider availability. That aside, for years, the Medicare Advantage plans issue provider directories filled with misleading information, and the federal government has not held them accountable for misleading their enrollees.

Here’s more from Just Care:

• Ten ways to improve Medicare Advantage
• Congress must overhaul the way it pays Medicare Advantage plans
• The price you pay for a narrow network
• OIG finds widespread inappropriate care denials in Medicare Advantage
• 2022: Medicare Advantage facts and figures