Denver Health is changing the way it enrolls Medicaid patients into its health insurance plan.
That's good news for doctors and low-income patients who say that Denver Health's "passive enrollment" system — which automatically enrolled any Medicaid patient with a Denver address into Denver Health's plan, restricting them to seeing only Denver Health doctors at Denver Health clinics — wasn't working for patients who had longstanding relationships with other physicians. Those patients didn't want to switch to Denver Health, they say, and the passive-enrollment system forced them to do so. Oftentimes, the patients didn't even know they'd been switched until they showed up for an appointment at their regular doctor and were told Medicaid wouldn't pay for it.
The new system is designed to "decrease the roadblocks" for patients who were "negatively affected" by the passive enrollment system, according to an e-mail sent to stakeholders from an official with the Colorado Department of Health Care Policy and Financing (HCPF). (The email was forwarded to Westword.) HCPF manages Colorado's Medicaid program, which is paid for with a mix of federal and state dollars.
This month, HCPF and Denver Health are implementing a new process that limits the types of patients who are passively enrolled in the Denver Health Medicaid Choice plan. Medicaid patients who are "attributed" to a non-Denver Health doctor will no longer be passively enrolled. Neither will foster children and newly arrived refugees who use the address of a Denver-based refugee resettlement agency as their personal address when signing up for Medicaid. Those refugees may not end up living in Denver, so it doesn't make sense for them to go to Denver Health.
A spokeswoman for Denver Health confirmed that the information in the e-mail is correct but said no one was available today to discuss the changes. Westword also contacted HCPF. We'll update this post if an agency official is available to comment.
The new rules go into effect on June 1. The e-mail notes that patients can still proactively choose the Denver Health plan. Otherwise, they can sign up for a plan that allows them to see any doctor who accepts Medicaid.
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The new rules will only affect new Medicaid clients, the e-mail says, not those who are already enrolled.
Dr. PJ Parmar doesn't think the new rules go far enough. Parmar has his own practice in Aurora where he serves refugees, most of whom are on Medicaid. He is one of the chief critics of the passive enrollment system and was featured in our September 2014 cover story on the topic, "Tough Medicine." Parmar thinks passive enrollment should be eliminated altogether, for everyone.
"This applies only to new enrollees," Parmar says, "which on the surface sounds like a pretty poor offer to me. Medicaid has over a million people (enrolled) already. ... What my nose tells me is this is actually a very small bone being thrown."