CHOICES enrollment is rising

County is switching to Blue Cross to reduce growing costs

Published: Thursday, July 1, 2010 at 6:01 a.m.
Last Modified: Wednesday, June 30, 2010 at 2:52 p.m.

After years of lower than expected numbers, enrollment in Alachua County's CHOICES health services program has seen a steady rise recently.

Now, county officials say an agreement with health care industry heavyweight Blue Cross Blue Shield will reduce the growing program's costs, extend its life and allow its members access to more doctors and service providers.

Under a contract county commissioners approved last Tuesday, Blue Cross Blue Shield takes over as the program's primary administrator effective Oct. 1. The move will save the county more than $700,000 next year, according to projections from the county's actuary firm Gallagher Benefit Services.

The county has sought to trim costs in order to keep the program going, at least until Jan. 1, 2014, when most of the federal health care reform legislation takes effect, Community Support Services Assistant Director Lanard Perry told commissioners.

Still, the county commissioner most closely tied with CHOICES opposes the change to Blue Cross Blue Shield. Cynthia Chestnut, who pushed for CHOICES approval in 2004, said she believed the projections of savings were based on incomplete information and painted too rosy a picture.

"I'm trying to follow the dollars and the dollars do not lead to a clear ending here," she said.

When the one-quarter cent sales tax paying for CHOICES passed by 85 votes in a referendum on the August 2004 primary ballot, the program initially was projected to provide up to 14,000 working uninsured residents with health access.

The program did not take off as expected. It began in October 2005 and had 455 members that year. Enrollment reached 1,000 in late 2007.

Over the years, the county has worked to boost enrollment, adding services such as dental, vision and some outpatient surgery and lowering the threshold of hours participants must work to be eligible, most recently to 20 hours a week in March. That move was made to accommodate workers who have had hours or benefits cut during the recession.

Meanwhile, the program has gained traction. Since February, enrollment has grown from about 2,600 to 3,094 on June 22, the highest enrollment to date.

CHOICES Director Bob Bailey said 300 to 400 applications come in a month.

Bailey said loosened eligibility requirements are not the only reason for the program's growth. "The community is having more confidence in the CHOICES program," he said. "It provides a benefit and people are seeing it will help them."

Based on an enrollment of 3,000 members, the decision to move to Blue Cross Blue Shield would reduce the CHOICES total expected costs next year from nearly $11.3 million to just below $10.6 million. The expectation is that medical claims costs will drop because Blue Cross Blue Shield's larger size allows it to negotiate with health care providers.

While overall savings are projected, under that 3,000-member scenario, Blue Cross Blue Shield would also charge just over $1 million in administrative costs to handle claims and billing. That's nearly $500,000 more than the county now spends with current third-party administrator Managed Care of America.

Chestnut said that would leave less money to provide services and that savings projections were based on incomplete information.

She also said Blue Cross Blue Shield would not handle claims related to CHOICES dental and vision programs or the Alachua County Organization for Rural Needs Clinic - areas the MCA contract covers. On the other hand, Blue Cross Blue Shield's contract would add areas not now covered - the CHOICES pharmacy benefit and disease management program.

Citing a conflict of interest, Chestnut recused herself when commissioners approved the Blue Cross Blue Shield contract 4-0. Chestnut is the director of Eastside Community Outreach and Education Coordination for Shands HealthCare, which contracts with the county to provide services through CHOICES.

She did, however, participate in the debate, making a presentation of her own to dispute the projected savings.

"As all of you know, CHOICES is my baby," she said. "I've been called the mother of CHOICES ... anyone is concerned when they think their child is at risk.

The one-quarter cent sales tax funding CHOICES expires at the end of 2011. To date, it has generated $55.6 million, with almost $40.9 million of that sitting in the program's trust fund. Of the approximately $14.7 million spent to date, $4.5 million has gone to cover administrative costs, expenses that include county staff's salaries, marketing and outreach programs, and administrative fees charged by the firms that handle billing and claims.

As enrollment has risen, administrative expenses have chewed up a lower percentage of the annual expenditures. Back in fiscal year 2006-07, when enrollment was below 1,000, more than half the program's total expenditures - $680,000 of $1.23 million - went toward administrative costs.

So far this fiscal year, those costs have been less than 20 percent of the total money spent - $888,790 of about $4.54 million.

Christopher Curry is a Gainesville Sun staff writer.

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