New England | Summer | 2008 | Health Plan Analysis

Publish date: August 2008

Tufts Health Plan wants to compete in the Rhode Island market, setting the stage for a showdown with Blue Cross & Blue Shield of Rhode Island, the state's no. 1 insurer, and UnitedHealthcare of New England. The expansion is not a done deal, since Tufts Health Plan officials are still negotiating provider networks. Tufts Health Plan pulled out of the Rhode Island market in the late 1990s and fellow Massachusetts health plan Harvard Pilgrim Health Care exited around 2000 amid financial troubles.

Also in Rhode Island, the Rhode Island Department of Human Services, with the backing of Gov. Donald Carcieri, has submitted a proposal to the Centers for Medicare & Medicaid Services to operate the state's Medicaid program under what is known as a "global cap." Under this scenario, the state would receive a defined financial contribution from the federal government, and would be solely liable for any amount spent over that pre-determined cap. In return, the Rhode Island would be granted complete flexibility to manage the Medicaid program.

Throughout New England, insurers are looking for ways to better control the costs of specialty drugs.

In Vermont, uptake has been slow in the state's program for the uninsured. As of the end of May, fewer than 4,000 were enrolled in the subsidized part of the program, compared to the original estimate of 6,000.