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Oregon Health Authority is working to manage a transition that will shift 96,000 Medicaid members in Lane County from PacificSource to Trillium. Some providers in behavioral health, already credentialed with PacificSource, say they were denied entry into Trillium’s network ahead of the switch and said they still lack clear answers.
The Oregon Health Authority on Wednesday, Dec. 3, hosted its first public listening session with providers on a coverage transition affecting nearly three of every four Medicaid members in Lane County.
PacificSource and Trillium are insurers that serve as coordinated care organizations, or CCOs, which manage care for people enrolled in the Oregon Health Plan, the state’s Medicaid program. The health authority in September ended contract negotiations with PacificSource as a Lane County CCO.
As a result, state officials plan for PacificSource Community Solutions to exit the county Jan. 31, with Trillium Health Plans taking over its members’ coverage Feb. 1.
Nearly 300 people listened in on the 7 a.m. online session geared toward health care providers. Officials with the Oregon Health Authority and leadership from PacificSource and Trillium were in attendance. The meeting comes as some providers who work with PacificSource say they have been denied by the Trillium network.
Kicking off with a presentation, Jerry Riener, a health system analyst with the state health authority, called the transition “significant,” affecting about 96,000 people in Lane County — roughly 4,000 more than PacificSource previously reported to Lookout Eugene-Springfield.
Riener reiterated the state’s promise that Oregon Health Plan members will not lose access to care during the transition. And he urged providers to direct patients with questions to the authority’s FAQ website.
Trillium is expected to more than triple its membership, growing from about 30,000 members to more than 100,000. Trillium executives, including senior Medicaid director Dominique Lopez-Stickney and Vice President of Network Development Brandie Thielman, said the organization is doubling its workforce to meet demandhiring some employees laid off by PacificSource.
The company said that about 90% of PacificSource primary care providers contract with Trillium, as do 84% of behavioral health providers. So far, Trillium has executed 37 provider contracts, including 22 in behavioral health that are in the process of becoming operational.
Lookout Eugene-Springfield has heard from mental health counselors under contract with PacificSource who said they applied to join Trillium’s network and were denied. One of them, Sarah Kaufman, is a licensed marriage and family therapist who works with clients experiencing post-traumatic stress disorder, addiction, anxiety, depression and who are transgender.
In a notice, Kaufman was told her contract was denied because of “network sufficiency.” The notice did not expand on what that meant.
“My concern is them [clients] being able to continue care of their choice that’s a good fit for their needs, and also their ability to continue to access any kind of quality care,” she said. “There’s still questions that need to be answered, and time is running short.”
Kaufman listened to Wednesday’s forum along with hundreds of others but said she still did not get the answers she was seeking. Other providers broached similar concerns about Trillium not credentialing therapists who are already in the PacificSource network.
The Oregon Health Authority and Trillium did not provide a clear timeline or specific direction for providers who received denials, saying only that the process is ongoing and that staff would follow up.
Lookout Eugene-Springfield asked Trillium for additional comment about denials. Spokesperson Courtney Johnston wrote in response, “We value our partnerships and collaboration with providers and encourage providers who have questions about network participation to reach out to us directly.”
Presenters, including Riener and Lopez-Stickney, said the state is prioritizing high-risk patients by care level to ensure medical records transfer smoothly. To do that, Trillium will serve “one person at a time,” Lopez-Stickney said.
“We start by understanding who our members are, their demographics, health challenges and social determinants,” she said. “Member needs evolve with life changes, policy changes and community trends, and our goal is to anticipate those changes and provide proactive, personalized support.”
The authority will start its listening sessions with members starting Saturday.
This story has been updated to reflect the correct spelling of Jerry Riener’s name.
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