'It makes you feel helpless': CareSource terminates Ohio marketplace contract with Cincinnati Children's

Cincinnati Children's Hospital Medical Center will be without an in-network Ohio marketplace provider beginning Aug. 1 after its last-standing partner recently terminated its contract. 

Dayton, Ohio-based CareSource Ohio, a Medicaid provider with more than 2 million members across six states, will stop covering patients who use the hospital and its physicians under the Ohio marketplace beginning on Aug. 1, a letter sent to parents from Cincinnati Children's on Monday said. 

The change affects 1,000 members who use the Ohio marketplace, which was created by the federal Affordable Care Act. It doesn't affect CareSource's Medicaid product.

The news Monday was met with ire from parents of those 1,000 children, who now must find new doctors or pay the out-of-network costs. They cited location, financial considerations and stability of care as factors that will be negatively affected by the change. 

"Those are decisions a parent should not have to make," said Melissa Reinert, of Bethel, whose 4-year-old son receives speech therapy at Cincinnati Children's. "Not in this country." 

Patients who were previously considered in-network with the hospital and its physicians under the marketplace will be considered "out of network" when the contract expires, the letter from Cincinnati Children's to parents explained. 

"Beginning on Aug. 1, 2022, you will be financially responsible for all new charges that are not covered by the plan," the letter sent out to parents read.

The termination means Cincinnati Children's, which employs around 16,500 people and was recently ranked third among all pediatric hospitals in the nation by U.S. News & World Report magazine, will be without coverage from an Ohio marketplace plan.

Five companies – CareSource, Ambetter by Buckeye Health, Anthem, Medical Mutual of Ohio, and Molina Healthcare – operate marketplace plans in southwest Ohio. CareSource was the last remaining marketplace provider that had a contract with Cincinnati Children's. 

Jennifer Tan, a spokeswoman for Cincinnati Children's, confirmed the termination in a statement to The Enquirer. 

"CareSource will soon change Cincinnati Children’s from 'in-network' to 'out-of-network' for CareSource Ohio Marketplace members, beginning August 1, 2022," Tan wrote. "We have contacted those affected and have begun to work with them to identify ongoing care options and to minimize financial burden whenever possible." 

"We are saddened by this occurrence and worked hard to try to avoid this circumstance," Christopher Scowden, Cincinnati Children's assistant vice president of contracting and payor relations, said in the letter sent to patients. 

Joseph Kelley, a spokesman for CareSource, said the parties were unable to reach an agreement on a Marketplace contract. 

"Our members rely on CareSource Marketplace plans for affordable health insurance," Kelley wrote in a statement. "In order to maintain that affordability, we work together with providers. We value our relationship with Cincinnati Children’s Hospital Medical Center and while we were hopeful we could come to terms, we were not able to reach a marketplace agreement."

Kelley added that CareSource is currently contracted with other children's hospitals across the state. 

Elizabeth Dietz, a Norwood resident whose two children with autism see a behavioral pediatrician at Cincinnati Children's, said she will have to consider whether to drive out of town to continue the specialized services. 

"It's crucial to have a longstanding relationship with your providers who know your children and who've been with their behavioral issues and been with their special needs since the beginning," said Dietz. "...There are no other behavioral pediatricians in our metro."  

The news was equally upsetting for Reinert, who said her son loves his speech therapist and has made great strides since beginning sessions at the hospital. 

"He's come so far," Reinert said of her son, "and it's frustrating that you essentially have to start over. ... Now we're stuck and to go find another insurance you have to wait until open enrollment period. It makes you feel helpless."

Reinert said she will begin looking for another speech provider that's in-network and discuss with her husband whether they can continue speech services for their son at all. 

CareSource and Cincinnati Children's launched a partnership in 2021 to improve care for 125,000 Medicaid-covered children in southwest Ohio. Under the partnership, Cincinnati Children's, which developed a HealthVine network to support the initiative, assumed "accountability for cure management and utilization management for the children." 

The network was designed to ensure children can access primary care as well as behavioral health services, Dr. Mona Mansour, a Cincinnati Children's pediatrician, said in a news release.