Maryland will drop Kaiser Permanente as a Medicaid managed care organization in 2025.
"After some lengthy contract negotiations, the [Maryland] Department of Health has elected not to enter into a contract with Kaiser and we are working to ensure a seamless transition of those enrollees to other health plans," MDH's deputy secretary of healthcare finance, told local radio station WYPR on Sept. 20.
Maryland recently temporarily suspended new enrollments in Kaiser's Medicaid plan, citing a failure to meet contractual obligations related to financial operations reporting requirements. It is not clear if Medicaid contract negotiations were related to the recent enrollment sanctions. Maryland is also implementing new health equity standards for managed care organizations in 2025.
Kaiser has held a Medicaid contract in Maryland for more than ten years, and it maintains the highest-rated Medicaid plan in the state, per the NCQA.
"If we are not able to participate in Medicaid, it would interrupt the highest-rated care and coverage of our more than 113,000 Medicaid members in Maryland in 2025," a spokesperson for Kaiser told Becker's. "We will continue to work with the Maryland Department of Health so we can continue serving this community for decades to come."
According to WYPR, the state will renew its existing managed care contracts, which includes Aetna, CareFirst BCBS, UnitedHealthcare, Elevance Health's Wellpoint, Jai Medical Systems, Maryland Physicians Care, MedStar Family Choice and Priority Partners.
Jai Medical Systems and MedStar Family Choice are independent companies. Maryland Physicians Care is owned by Ascension Saint Agnes, Holy Cross Health, Meritus Health, and UPMC Western Maryland. Priority Partners is owned by Johns Hopkins Health Plans and the Maryland Community Health System.
"The Maryland Department of Health is working through implementation of their Medicaid reporting requirements, and Kaiser Permanente's value-based model reports care and services differently than traditional, fee-for-service health plans," the Kaiser spokesperson said. "Kaiser Permanente's approach is based on getting the best outcomes for our members, in terms of effectiveness, affordability, and quality. We are the highest rated plan in the region because our expert, coordinated care and services prioritize the right care, at the right place and time for each patient, as compared to fee-for-service systems which are based on billable services that align with revenue generation. Those services may be easier to track, but that doesn't mean they deliver the best care or outcomes for the patient."
"We have been working with the Department for some time to explain our integrated system of both care and coverage and propose ways to apply the department's reporting requirements to our model. We will continue to work to get to a solution that meets the department's needs and ensures that our Medicaid-covered members can continue to get the best care and service from Kaiser Permanente without disruption."