Wilmington, Del.-based Nemours Children's Health terminated contracts with two major insurers and is phasing out care for more than 10,000 children with disabilities, NJ Spotlight News reported Aug. 2.
The hospital treats roughly 11,000 children from New Jersey each year who are enrolled in New Jersey FamilyCare, a Medicaid program, through Horizon Blue Cross Blue Shield of New Jersey and Amerigroup. The transition was set to begin Aug. 1 and may last up to a year. Nemours said it will continue to accept children with managed care plans from WellCare, but is not "currently" seeking a $10 million grant lawmakers added to expand access to pediatric care.
"Despite our best efforts, and our willingness to be flexible in order to remain in network, we were disappointed that Amerigroup and Horizon were unwilling to work with us to provide fair and equitable reimbursement rates," Nemours said in a statement to the news outlet. "Recognizing the importance of this matter to our patients and our continued goal to serve the New Jersey community, Nemours remains open to further discussions with New Jersey (Medicaid) plans and the State regarding equitable and sustainable compensation models for pediatric care."
In April, Nemours warned physicians and families with New Jersey FamilyCare plans that it might exit the state's managed -care network because of low payment rates that resulted in "tens of millions" in losses from caring for New Jersey pediatric patients.
A Horizon spokesperson told NJ Spotlight News that the insurer had negotiated contracts with rate increases for Nemours in 2021, 2022 and 2023. He said Horizon would honor its contract if Nemours reversed its decision and that the company would support Medicaid members in finding other care options.
Amerigroup told the news outlet it was "surprised and disappointed" in Nemours' decision, as their contract was not set to expire until 2026. It said the contract "included rates favorable to Nemours, above the base New Jersey Medicaid fee for service rates," and that the company was committed to minimizing disruption in care for patients affected by the change.
Families of children with rare and complex medical conditions and legislators have expressed anger over the results of the contract dispute.