PacificSource files ‘transition plan,’ a step in its exit from Lane County Medicaid care

PacificSource has submitted its transition plan to the Oregon Health Authority, a major step in the insurer’s exit from its contract serving nearly 90,000 Medicaid members in Lane County.

The Springfield-based insurer notified the state Sept. 18 that it planned to not renew its contract to operate in Lane County as a coordinated care organization, managing care for people enrolled in the Oregon Health Plan, the state’s Medicaid program. Its contract ends Jan. 1.

PacificSource also offers commercial insurance and Medicare plans, which are unaffected by this transition.

PacificSource will continue to serve Oregon Health Plan members in eight other Oregon counties. Company leaders cited unsustainable losses specific to Lane County as the reason for the withdrawal.

PacificSource spokesperson Lauren Thompson told Lookout-Eugene Springfield by email on Thursday, Oct. 9, that the company submitted its transition plan, but she did not elaborate on its details.

The Oregon Health Authority hasn’t yet released the transition plan, which Lookout Eugene-Springfield requested Thursday. When asked about the transition plan, health authority spokesperson Amy Bacher sent the following statement: 

“The most important thing for OHP members to know right now is that OHP coverage has not changed and there is continued access to health care. As part of the current contract, PacificSource is required to provide services during the process of locating another network provider. There will be no immediate changes to benefits for providers, community members or OHP members.”

The statement said the health authority has a process for making sure community care organization coverage continues in Lane County.

“We’ll continue to follow those steps. OHA is moving with urgency and care, recognizing the impact this has on people’s lives. Moments like this necessitate innovation and collaboration. We’re working with partners to identify solutions that meet the goals to best serve OHP members and the people of Lane County.”  

In a Sept. 30 presentation to a state House health care committee, Dave Baden, OHA’s deputy director for policy and programs, outlined the steps required under state law.

First the authority needs to determine whether one coordinated care organization can serve the region. If so, members would move to that organization — in Lane County’s case, Trillium.

About 90,000 Lane County’s Medicaid members rely on PacificSource’s coordinated care organization, while Trillium has about 30,000 members. 

Trillium spokesperson Courtney Johnston said the organization has the capacity to take on the 90,000 PacificSource members, but Trillium is still working with the state to determine whether that will happen.

Physicians, patients and Lane County commissioners have expressed concern about whether Trillium has an adequate provider network. 

If the health authority decides two coordinated care organizations are needed, it must announce an opening, review letters of intent and evaluate applicants’ ability to serve the county. PacificSource could reapply but has not said it will.

Baden said the health authority typically has about six months between selecting a new coordinated care organization and starting coverage. He also said officials do not yet know what changes Oregon Health Plan members might face.

If a new provider is needed, but hasn’t been secured by the new year, the agency can order PacificSource to continue services for another 90 days, once the health authority approves its transition plan.

This story has been updated to correct the spelling of Courtney Johnston’s name.

— Ben Botkin contributed to this report.