Centene’s ‘Ohana Health Plan is leaving Hawaii’s Medicaid managed care program, QUEST, on Dec. 31, according to a Sept. 1 letter to plan members.
Centene also did not bid on the contract for Community Care Services, a behavioral health managed care program. Centene’s work under this contract ends Oct. 31, according to a statement shared with Becker’s Oct. 19.
The Honolulu-Star Advertiser reported the Medicaid transition will affect 24,000 members. A Centene spokesperson said the insurer has served the community for nearly two decades. The spokesperson attributed the exits to rising medical costs, reimbursement rates that were not keeping pace with the population’s needs and federal funding changes.
“We are no longer able to continue operating these programs in a sustainable manner while maintaining the level of service our members deserve,” the statement said.
Several HR 1 provisions, including Medicaid work requirements and more frequent redeterminations, will go into effect in 2027.
The health plan’s letter said a special open enrollment period is taking place Oct. 1-20, allowing members to select another plan. Med-QUEST, the division that oversees the Medicaid program, will choose plans for members who do not select an alternative.
“Our focus now is on ensuring a smooth and orderly transition for our members, providers, community partners and employees,” the spokesperson said.
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