Tags: affordability

A pair of stories in the Boston Globe and the Boston Business Journal are reporting that Neighborhood Health Plan (NHP), an affiliate of Partners HealthCare, and MassHealth have instituted a temporary enrollment freeze on new MassHealth members joining NHP. This action, which does not affect existing NHP MassHealth members, was necessitated by continuing material losses in NHP’s MassHealth business.

One of the reasons for these losses is that NHP, on average, pays hospitals higher than the benchmark set forth in its MassHealth contract. However, it is important to note that with the exception of transplants, all Partners hospitals meet that benchmark. During the temporary enrollment freeze, all new MassHealth members will continue to have access to Partners hospitals—including Mass General and Brigham and Women’s—through MassHealth’s Primary Care Clinician (PCC) plan.

NHP continues to be the largest Medicaid managed care organization in Massachusetts, with more than 300,000 MassHealth members—two-thirds of its total membership. The temporary enrollment freeze is intended to put NHP’s MassHealth business on a more solid financial footing so that it can continue to participate in the program to which it’s been committed for 30 years.