Centene Pulls Out of Hawaii and Arkansas Medicaid Programs
Centene is leaving Hawaii's QUEST and Arkansas's ARHOME Medicaid programs. What practices should check before patients move to new plans in January.
Hawaii
Centene's 'Ohana Health Plan is leaving QUEST, Hawaii's Medicaid managed care program, on December 31. Its 24,000 members will move to AlohaCare, HMSA, Kaiser Permanente or UnitedHealthcare Community Plan, depending on what is offered on their island, and Med-QUEST is assigning a plan to anyone who didn't pick one. Centene's Wellcare By 'Ohana Medicare Advantage plan isn't renewing for 2027 either, so check your Medicare patients too. Centene also didn't rebid Hawaii's Community Care Services behavioral health contract, and that work ends October 31.
Arkansas
In January, about 70,000 Arkansans in ARHOME, the state's Medicaid expansion program, will be moved off Centene plans. Centene announced in July that it would leave after 13 years, which leaves the Arkansas Blue Cross and Blue Shield family of plans (Arkansas Blue Cross, Health Advantage and Octave) as the only option. If you aren't contracted with Arkansas Blue Cross, there is no other ARHOME plan for those patients to land in. Arkansas Total Care, Ambetter and Centene's Medicare business are staying, so those contracts remain in place.
Why Plans Are Leaving
Centene pointed to costs and funding. When states restarted eligibility checks after the pandemic, healthier members dropped off first and the people who stayed cost more to cover. State rates are built on claims data that can lag current costs by a year or more, so plans have been paying out more than the rates support. KFF found the average medical loss ratio for Medicaid managed care rose from 88% in 2023 to 91% in 2024. With HR 1 work requirements, six-month redeterminations and caps on provider taxes still ahead, there is a high likelihood of more exits in the future. Contract inventory reviews need to become a regular part of the year.
Check Your Contract Inventory
I've seen clients caught unprepared when a plan leaves a Medicaid managed care program and its patients shift to a network the practice was never enrolled with. Those patients keep showing up, claims start denying in January, and getting enrolled with the new plan can take months.
A small amount of time spent reviewing your contract inventory now is well spent. Start with the patients currently on the exiting plans and check whether you're credentialed and contracted with the plans they're moving to. If you aren't, get those enrollments started before year end. And don't forget the claims and authorizations still open with Centene, because they need to be worked before they age past timely filing during the run-out.
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About the author
Tony Kuka · Founder, Ziurta
Tony is the founder of Ziurta, a provider enrollment platform for medical practices, health systems, RCM firms, and credentialing companies. He has 30 years in healthcare administration, including 20 building outsourced revenue cycle companies, and founded and sold Medical Business Office and National Credentialing Solutions. He is based in Chattanooga, Tennessee.