Baystate Medical Center in Springfield is facing a contract impasse with a major Medicaid health insurer.
Boston Medical Center’s HealthNet program covers 50 thousand of Baystate’s medicaid patients — that means, BMC pays Baystate for care and then gets reimbursed by the state. But BMC says it’s been paying higher rates to Baystate than the organization can afford, while Baystate says it’s been accepting less money than it needs. Kevin Klein of BMC.
“The dynamics of this relationship as it existed recently just don’t work,” says Klein.
The contract is scheduled to expire on December first, but Baystate CEO Mark Keroack says the parties are negotiating over a later date so patients have time to adjust. He says they could switch to other hospitals that still work with BMC, including Cooley Dickinson or Mercy.
“The real rub comes in pediatric care where virtually all of the specialty pediatrics is offered by Baystate,” says Keroack.
Another option is for BMC patients to switch to a more traditional Medicaid plan, which would allow them to use Baystate services but lose other benefits that BMC provides. Or they could sign up for Health New England, a managed care plan owned by Baystate itself.
The state’s Department of Health and Human Services has also been involved in the contract negotiatons between the two parties.