CHC is sole provider for children with Medicaid

Children from low income families who are eligible for Medicaid benefits can only be treated at the Commonwealth Health Center due to a revised Medicaid state plan that limits the participation of private providers.

Private providers that once accepted children with Medicaid no longer accepts them because the state plan prohibits them from doing so.

According to Commonwealth Healthcare Corp. chief executive officer Esther Muña, the hospital now has enough pediatricians and doctors to provide healthcare services to children.

CHC has six pediatricians and seven internal medicine doctors.

Marianas Medical Center and Saipan Health Clinic confirmed with Saipan Tribune yesterday that they only accept Medicaid patients who are 18 years old and above.

Latest data from the CNMI Medicaid Office show that as of September 2014, over 7,000 children are either applicants or dependents under Medicaid.

The Medicaid Office confirmed with Saipan Tribune yesterday that they no longer have contracts with private clinics for children with Medicaid because CHC has pediatricians and is certified for it.

Those who once went to Marianas Medical Center, Pacific Medical Center, and Saipan Health Clinic to avail of Medicaid services for their children now have to go to CHC.

Families of many Medicaid children are, however, worried if the hospital could handle the increased capacity.

A mother of three in Dandan told Saipan Tribune she is worried because waiting to be seen by a physician at the public hospital could take hours.

“This is difficult because they cannot accommodate all patients and it will be okay if they can. It takes too long. I don’t agree that CHC should be the only one. The more the better,” she said.

Another mother of two from China Town said she used to go to MMC for her children who are under Medicaid. She only found out about the changes when she called MMC for an appointment for her two children and MMC told her that they do not accept Medicaid for children anymore.

CHCC says…

Muña said that, with the recent hire of several physicians, to certify that they do not have enough staff is inaccurate.

“We haven’t certified that we have a staffing shortage. Because of that, [child Medicaid patients] don’t have an option [to go to private clinics]. The only time they have an option is if CHC does not have [enough physicians]. That is what the state plan states,” Muña said.

The revised state plan, which has been approved by the U.S Department of Health and Human Services Region 9, requires Medicaid patients to first seek treatment from CHCC and does not allow private clinics to provide services to Medicaid beneficiaries unless CHCC is not able to accommodate the patients.

Muña said that despite all this, she is closely monitoring the Medicaid situation.

“Even though I could not certify that we don’t have the physicians—because we do have the physicians—I am closely monitoring to basically evaluate the situation,” she said.

“I personally think that CHCC should not only be the option and I am actually looking into it,” she added.

The whole purpose of the state plan was to help the Medicaid program meet its financial goals because they had a cash flow issue in 2012. Muña said that when she became CEO she certified that they lacked staff, and that it was CHCC’s ultimate goal to get more healthcare providers.

“We were cited by the Centers for Medicare and Medicaid Services for not opening the clinic because we didn’t have the staff. We were cited for not having a pediatric clinic and the whole goal was to have these physicians and we have them now,” Muña said.

She said it is not her intention to stop Medicaid patients from seeing private providers.

“I want to be able to make sure that we do have an option for patients for whatever reason that they seek help and that we need to open up for private providers once again,” she said.

She said in the next couple of weeks, she will look at the numbers and Medicaid-eligible numbers and expand it again and try to certify that other private clinics have that option to see Medicaid patients.