News Summary
Weill Cornell Medical Center NewYork-Presbyterian has terminated its contract with Healthfirst, affecting thousands of Medicaid patients. The termination takes effect on November 3, leaving around 200,000 Healthfirst members to pay out-of-pocket for non-emergency services at the facility. The abrupt decision follows ongoing disputes and raises concerns about healthcare accessibility for low-income communities. The hospital system, facing scrutiny from the DOJ for potential antitrust violations, is seeking to negotiate a new agreement with Healthfirst while the labor union calls for a federal investigation into the matter.
New York City – Weill Cornell Medical Center NewYork-Presbyterian has officially terminated its contract with the nonprofit insurance provider Healthfirst, affecting thousands of Medicaid patients who rely on the insurance for medical care. The termination will take effect on November 3, requiring these patients to pay out-of-pocket for all medical services provided at New York-Presbyterian facilities, except in emergency situations.
The decision to exit Healthfirst’s network was communicated to the insurer in early July, despite the original contract being set to last until 2027. This abrupt end to the agreement raises concerns for the approximately 200,000 Healthfirst members who utilized New York-Presbyterian services in the past year.
In addition to New York-Presbyterian, affiliated physicians’ practices, including Weill Cornell Medicine and Columbia Doctors, are also set to stop accepting Healthfirst patients by November. This change is particularly concerning for the low-income communities that Healthfirst serves, as the organization covers around one-third of all Medicaid enrollees in the downstate region, providing insurance to about 2 million New Yorkers.
Patients who are currently receiving ongoing treatment at New York-Presbyterian may seek authorization from Healthfirst in order to continue their coverage, although the process and chances of approval are still unclear as the transition approaches.
The decision to terminate the contract comes less than a year after a new reimbursement rate agreement was negotiated between New York-Presbyterian and Healthfirst. Despite this newly established agreement, the early termination has left many patients, as well as both healthcare providers and insurance representatives, puzzled over its motivations and implications.
Healthfirst has publicly expressed its commitment to finding a fair resolution with New York-Presbyterian. Meanwhile, the hospital has reaffirmed its intention to negotiate a new agreement with Healthfirst, but details about those negotiations have not been disclosed.
The termination of the contract is not isolated; it is part of ongoing disputes involving New York-Presbyterian and its insurance practices. The hospital system reported an operating revenue of approximately $13 billion last year, highlighting its substantial influence in the healthcare market. However, this financial success comes against a backdrop of scrutiny as the Department of Justice investigates the hospital for potential antitrust violations related to its insurance practices.
Additionally, the labor union 32BJSEIU has called for a federal investigation into possible agreements that may restrict competition and potentially enable New York-Presbyterian to charge higher prices. The union’s concerns reflect a broader apprehension about the financial accessibility of healthcare for low-income patients in the community.
As the situation develops, the focus remains on how the termination will impact thousands of patients and whether a sustainable resolution can be achieved to provide effective care under Medicaid coverage for those enrolled with Healthfirst.
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Additional Resources
- Crain’s New York
- Wikipedia: New York-Presbyterian Hospital
- The New York Times
- Google Search: New York-Presbyterian contract termination
- Everyday Health
- Google Scholar: New York-Presbyterian insurance dispute
- ABC 7 NY
- Encyclopedia Britannica: New York-Presbyterian Hospital
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