North Carolina's Healthy Blue Care Together Plan Faces Implementation Hurdles, Affecting Foster Children's Healthcare Access
North Carolina's specialized managed care insurance plan for foster children, Healthy Blue Care Together, launched in December, has encountered significant implementation difficulties. These challenges include initial gaps in its provider network, leading to critical issues for beneficiaries, such as 8-year-old Ollie Super, who faced a temporary denial of essential cancer treatment coverage. The plan, administered by Blue Cross Blue Shield of North Carolina, has been urged by state officials to expand its network amid reports of systemic problems affecting healthcare access for this vulnerable population.
Introduction to the Plan
On December 1, North Carolina rolled out Healthy Blue Care Together, a specialized managed care health insurance plan. Operating as part of Medicaid, the plan aims to enhance healthcare access for approximately 32,000 children currently in or adopted from foster care. These specialized plans are specifically designed to address the often complex medical needs characteristic of this population.
Implementation Challenges and Provider Network Gaps
Upon its December 1 launch, the plan faced immediate hurdles as thousands of healthcare providers who previously accepted standard Medicaid were not initially included in the Healthy Blue network. This oversight created considerable uncertainty for families regarding coverage and their ability to access necessary care.
UNC Health, a major healthcare provider in the state, initially did not participate in the plan. An agreement between UNC Health and Blue Cross Blue Shield of North Carolina, the plan's administrator, was finally reached in mid-March, approximately two months after initial issues emerged.
Despite this agreement, some North Carolina doctors continue to not accept Healthy Blue insurance.
Melanie Bush, interim deputy secretary for North Carolina's Medicaid program, has stated her office urged Healthy Blue to expand its provider network, though she characterized the current network as "adequate." Blue Cross Blue Shield of North Carolina has not publicly disclosed the exact number of covered providers.
Systemic Issues and Patient Impact
Further problems reported extend beyond network gaps. Difficulties with transferring healthcare records to the statewide database managed by Healthy Blue have been cited. These issues have impacted the tracking of patient histories, access to online portals, obtaining prescriptions, and have been linked to delays in surgeries and appointments. These challenges have been particularly noted by caregivers of children with complex medical needs.
Case Study: Ollie Super
Ollie Super, an 8-year-old diagnosed with recurrent neuroblastoma, required CAR T-cell therapy at UNC Health. In early March, her family was initially informed that the new state insurance would not cover the treatment due to UNC Health's non-participation in the plan.
The agreement reached in mid-March between UNC Health and Blue Cross Blue Shield of North Carolina subsequently resolved Ollie's coverage issue for the critical CAR T-cell therapy. However, Ollie's cancer had spread by mid-March, necessitating additional chemotherapy before she could begin the CAR T-cell therapy. Her family is now preparing for ongoing travel for her treatments, which carry significant costs.
National Context and Expert Observations
North Carolina is one of 14 states with specialized foster care plans, which vary in their structure and implementation across the country. Other states, including Texas, Florida, Illinois, California, and Georgia, have also reported challenges with the implementation of similar plans. These difficulties include limited provider networks, inadequate access to specific services like mental health, and issues leading to investigations by regulatory bodies.
Karen VanLandeghem of the National Academy for State Health Policy noted that four states have initiated such plans in the last five years, with more anticipated. Medicaid policy analysts highlight that few states publish data on these programs' performance, making it difficult to assess their effectiveness or understand the reasons for implementation problems.
Andy Schneider, a research professor at Georgetown University's Center for Children and Families, described the adoption of these plans without sufficient supporting data as "experimental."