Caresource ends Ohio market agreement with Cincinnati children

Cincinnati Children’s Hospital Medical Center will be without an Ohio market provider in the network beginning Aug. 1 after its last partner recently terminated its contract.

CareSource Ohio, based in Dayton, Ohio, a Medicaid provider with more than 2 million members in six states, will stop covering patients who use the hospital and its doctors in the Ohio market starting August 1, a letter sent to Cincinnati Children’s parents said Monday.

The change affects 1,000 members who use Ohio’s marketplace, which was created by the federal Affordable Care Act. This does not affect CareSource’s Medicaid product.

Monday’s news angered the parents of those 1,000 children, who now have to find new doctors or pay out-of-network fees. They cited location, financial considerations and stability of care as factors that will be negatively affected by the change.

“These are decisions a parent shouldn’t have to make,” said Melissa Reinert, of Bethel, whose 4-year-old son is receiving speech therapy at the Cincinnati Children’s. “Not in this country.”

Patients who were previously considered in-network for the hospital and its in-market physicians will be considered “out-of-network” when the contract expires, the Cincinnati Children’s letter to parents explains.

“Starting August 1, 2022, you will be financially responsible for any new fees that are not covered by the plan,” reads the letter sent to parents.

The termination means Cincinnati Children’s, which employs about 16,500 people and was recently ranked third among all children’s hospitals in the nation by US News & World Report magazine, will not be covered by an Ohio market plan.

Five companies — CareSource, Ambetter by Buckeye Health, Anthem, Medical Mutual of Ohio, and Molina Healthcare — operate market plans in southwestern Ohio. CareSource was the last remaining market provider to contract with Cincinnati Children’s.

Jennifer Tan, spokeswoman for Cincinnati Children’s, confirmed the dismissal in a statement to The Enquirer.

“CareSource will soon transition Cincinnati Children’s from ‘in-network’ to ‘out-of-network’ for CareSource Ohio Marketplace members, effective August 1, 2022,” Tan wrote. “We contacted those affected and began working with them to identify options for continued care and minimize the financial burden where possible.”

“We are saddened by this event and have worked hard to try to avoid this circumstance,” Christopher Scowden, assistant vice president of contracts and payer relations for Cincinnati Children, said in the letter sent to patients.

Joseph Kelley, a spokesperson for CareSource, said the parties were unable to come to an agreement on a Marketplace contract.

“Our members rely on CareSource Marketplace plans for affordable health insurance,” Kelley wrote in a statement. “In order to maintain this affordability, we are working with vendors. We value our relationship with Cincinnati Children’s Hospital Medical Center and while we hoped we could get along, we were unable to reach a market agreement.”

Kelley added that CareSource is currently under contract with other children’s hospitals across the state.

Elizabeth Dietz, a Norwood resident whose two autistic children are seeing a behavioral pediatrician at Cincinnati Children’s, said she will have to consider leaving town to continue specialist services.

“It’s crucial to have a long-standing relationship with your providers who know your children and have dealt with their behavioral issues and special needs from the start,” Dietz said. “…There are no other behavioral pediatricians on our subway.”

The news was equally heartbreaking for Reinert, who said her son adores his speech therapist and has made great progress since beginning sessions at the hospital.

“He’s come so far,” Reinert said of his son, “and it’s frustrating that you basically have to start over. … Now we’re stuck and to find another insurance you have to wait until the enrollment period. open. It makes you feel helpless.”

Reinert said she would start looking for another speech therapy provider in the network and discuss with her husband the possibility of continuing speech therapy services for their son.

CareSource and Cincinnati Children’s launched a partnership in 2021 to improve care for 125,000 Medicaid-covered children in Southwest Ohio. As part of the partnership, Cincinnati Children’s, which developed a HealthVine network to support the initiative, assumed “responsibility for treatment management and utilization management for children.”

The network was designed to ensure that children can access primary care as well as behavioral health services, Cincinnati pediatric pediatrician Dr. Mona Mansour said in a press release.