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Sunday, Oct 1, 2023

Health Healthy families dedicated to retaining enrollees

Prudential Managed Care Members to Lose Sharp’s Services at Contract’s End

As coordinators of the Healthy Families insurance program struggle to boost enrollment of eligible children, they also are faced with the uphill battle of retaining children.

According to the Health and Human Services Agency in San Diego County, 11,369 children were enrolled in the subsidized health insurance program from July through December of last year.

During that same period, 46.7 percent, or 5,306 children, dropped out of the program mainly for two reasons: Parents failing to submit paperwork to re-enroll their children; and a lack of understanding from parents why they should have to pay monthly premiums if their children are healthy, said Dianne Williams, program manager of the San Diego Kids Health Assurance Network.

“That is a huge concern for us,” said Williams about the number of disenrolled children. “We are working with parents to (make them aware of the) need (to re-enroll their children) and preventative use of health insurance and to understand the system of enrollment.”

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As of Feb. 19, there are 30,547 children enrolled in the Healthy Families Program, a state program to provide health insurance for children of indigent families.

The total number of eligible children in the county is 37,216, according to Health and Human Services.

From January 2000 through December 2000, the program enrolled 20,927 children.

At the same time period, roughly one-third, or 7,676 children, dropped out, Williams said.

Program coordinators have been working hard to boost enrollment and ward off disenrollment, she said.

These efforts include helping families with the application process and providing educational material to stress the need for preventative health care and dental care, Williams said.

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Sharp Ends Contract With Prudential: Sharp HealthCare hospital system recently ended its contract with Prudential’s managed care plans, citing low reimbursement and too few patients.

The contract, which ends April 1, affects 3,500 Prudential members living in San Diego County.

They will then no longer be able to seek care at five Sharp hospitals , Sharp Chula Vista, Grossmont Hospital, Sharp Coronado, Mary Birch Hospital and Sharp Memorial La Jolla , and one skilled-nursing facility.

The contract termination reportedly resulted from the merger between Prudential and Aetna in August 1999.

Since then, Prudential members have been switched to Aetna.

This resulted in a drastic decline of Prudential members in the county.

To make business viable, Sharp said it needed to get higher reimbursement, but failed to reach an agreement with Prudential, the California Healthcare Foundation reported in a newsletter March 6.

Still, patients who have already scheduled procedures approved by Sharp will not be affected.

Women in their second and third trimester of pregnancy will still be able to access Sharp facilities. But women in their first trimester must get approval from Aetna Patient Management, according to the newsletter.

To submit health care news, please write to mwebb@sdbj.com.


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