ATC Medicaid managed care plan scaling back in Upstate

COLUMBIA, SC—Approximately 8,100 South Carolina Medicaid beneficiaries in the Upstate who are enrolled in the Absolute Total Care (ATC) managed care plan will soon be asked to choose another plan, the South Carolina Department of Health and Human Services (SCDHHS) announced Wednesday. The announcement comes after ATC notified the Department it intends to withdraw from participation in Spartanburg, Cherokee and Union counties.

ATC also will notify an additional 5,200 of its members in Greenville, Laurens and Pickens counties that they will have the option of switching to another Medicaid managed care plan if they choose. This is the result of the loss of Regional HealthPlus in Spartanburg as an ATC network provider which may affect access for some members in these counties. ATC members will have 90 days to make this choice.

SCDHHS requires plans that enroll Medicaid beneficiaries to maintain a robust network of primary care physicians, hospitals and specialists. As a result of the review of ATC’s Greenville, Laurens and Pickens counties network, the department will also require ATC to broaden its network of providers in these counties over a 90 day period. New members will not be enrolled in ATC in these counties until additional local capacity is created in the ATC network.

Spartanburg, Cherokee and Union county enrollees:

ATC enrollees in these counties will begin receiving letters from ATC explaining the withdrawal this week. Beginning Aug. 19, enrollees will have 30 days to choose from up to six other Managed Care Organizations or Medical Homes Networks available in these counties. Health care providers who contract with ATC will be notified of the change and are asked to work with affected beneficiaries in helping them select another plan. If enrollees do not make a choice, they will be automatically assigned to another plan. Anyone dissatisfied with the new plan assignment will have 90 days to choose a new plan.

Greenville, Laurens and Pickens county enrollees:

Enrollees in these counties also will begin receiving letters this week. They will be notified of the option of selecting another plan within 90 days. If they do nothing, they will continue their enrollment in ATC.

To ask questions about the change or to enroll in a new plan after Aug.19, ATC enrollees in the counties are encouraged to call 1-877-552-4642. Other plan choices in those counties include:

• BlueChoice Health Plan
• Carolina Medical Homes
• First Choice by Select Health
• Palmetto Physician Connection
• South Carolina Solutions
• UnitedHealthcare Community Plan

ATC, a subsidiary of Centene Corporation, has contracted with SCDHHS since 2007 and serves approximately 84,600 South Carolina Medicaid enrollees in 40 other counties. Please note: the changes announced Wednesday do not affect ATC Medicaid enrollees in other counties.

In order to encourage greater care coordination and improve health outcomes, most Medicaid beneficiaries in South Carolina must enroll in either a Managed Care Organization or a Medical Homes Network through the Department’s Healthy Connections Choices program. More than 560,000 South Carolinians are currently enrolled in a Medicaid coordinated care plan.

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