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No decision yet on Medicaid extension to private clinics
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Posted on Jun 26 2015
Despite a June 30 deadline, the Commonwealth Healthcare Corp. has yet to make a decision on whether to extend anew the use of Medicaid insurance to private clinics.
So far, CHCC has doctors to accommodate the needs of the community and CHCC chief executive officer Esther Muna has yet to issue a certification requiring help from private clinics to the CNMI Medicaid Office.
“When I make the certification, I am certifying that the hospital does not have the physicians. That is the certification, but I am not certifying anything yet, because I have the doctors,” Muna said.
“However, I am not saying that I won’t need the help of the private clinics. Anything can change today, tomorrow, or the next week if I receive notice that we don’t have adequate providers. I don’t make a predetermination. It all has to be supported by data, the numbers. So anything can change,” she added.
There are three main clinics that accept Medicaid patients—Saipan Health Clinic, Pacific Medical Center, and Marianas Medical Center. Muna has to write to CNMI Medicaid that CHCC does not have the physicians.
Earlier, Muna wrote to CNMI Medicaid that “to ensure community health needs are met, CHCC will need the assistance of private practitioners for outpatient services provided to adults and children, therefore extending an agreement allowing private clinics to accept Medicaid patients both under and above 18 years old for outpatient services [is needed] until June 30.”
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 at CHCC and does not allow private clinics to provide services to Medicaid beneficiaries unless CHCC is not able to accommodate the patients.
The whole purpose of the state plan is to help the Medicaid program meet its financial goals because they had a cash flow issue in 2012.
The CNMI Medicaid Office’s latest data shows that it has had more than 5,000 Medicaid applicants so far this year.
The only time that CHCC is able to certify services and seek help from private clinics is if CHCC is not able to accommodate the patients.
