Children's Mercy exits Kansas City ACA market

Kansas City-area families who bought health insurance through the Affordable Care Act marketplace lose access to Children’s Mercy Hospital on January 1. The hospital announced the network change recently. It estimates about 400 of its current patients will be affected by the move. Medica, the insurer providing these plans in the region, is exiting several counties in Kansas and Missouri. This leaves residents with no ACA marketplace plan that covers the hospital next year.

The primary driver of this disruption is Medica's decision to leave specific geographic areas. The insurance company is withdrawing from Johnson and Wyandotte counties in Kansas. It is also exiting Jackson, Clay, Johnson, Lafayette, Platte, and Ray counties in Missouri. Hospital spokesperson Lisa Augustine confirmed these details in an email sent on October 22. People with employer-sponsored insurance, Medicare, Medicaid, or TRICARE are not impacted by this specific change. The issue only affects individuals who purchased coverage through the federal marketplace using Medica policies.

Parents in the metro area are scrambling to find new coverage or new doctors. Christy Moreno, a single mother of two, said her 16-year-old daughter requires frequent specialist appointments at Children’s Mercy. Moreno said she switched to Medica last year after other plans dropped the hospital. Her monthly premium for her household is nearly $1,950. She took out a home equity loan and took on three jobs to pay off medical debt. She described the situation as increasingly difficult for families without government subsidies.

The hospital says it is working to help affected families during the transition. Augustine stated that the 400 impacted patients do not include those seeing doctors at the 31 pediatric clinics owned by the hospital. However, those clinics will also be out of network for marketplace clients in the affected counties. The hospital created a webpage with updates and frequently asked questions. It listed a phone number, (816) 302-1650, for questions. Augustine said the hospital wants to participate in the marketplace and continues to speak with other insurance plans to seek inclusion in their networks.

Regulators on both sides of the state border say they lack the power to force a deal. Angela Nelson, director of the Missouri Department of Commerce and Insurance, said the department is speaking with Children’s Mercy and all individual coverage insurers in the region. She stated that patients should never be used as bargaining chips in contract negotiations. She noted that the department has no authority to intervene in the contract talks. Holli Kroeker, director of communications for the Kansas Department of Insurance, said the Kansas agency also reached out to insurers and the hospital. She explained that the federal Centers for Medicare and Medicaid Services holds jurisdiction over network adequacy for individual ACA marketplace plans.

Families are expressing frustration over the lack of transparency in the process. Kasey Jackson, a Leawood resident, said her 13-year-old son is halfway through a two-year treatment plan for acute lymphoblastic leukemia at Children’s Mercy. Jackson said the hospital is the only option for her son in the region. She and her husband sold their business to care for him. She said the family feels betrayed because they donate to the hospital but are now losing access. Jackson’s social media post about the issue attracted attention from national figures, including the children’s educator Ms. Rachel.

Some families are considering drastic measures to maintain access to care. David Hawkins, a father of four near Parkville, Missouri, said he and his wife switched insurance four times in the last four years to stay in network with their pediatrician. He said he has considered moving to a different state with more insurance options. Kathryn Orr, a Fairway, Kansas resident, paid $5,000 on a credit card to see a specialist at the Mayo Clinic in Minnesota. She had to go out of state because her daughter could not wait for an in-network appointment at Children’s Mercy.

The hospital says it is committed to delivering specialized care for children. Augustine said the team is focused on helping families navigate their coverage options. She acknowledged that the news is hard to hear, especially for families with children in treatment. The hospital’s website states that it continues to speak with insurance plans in an effort to seek inclusion in their networks. Medica did not respond to requests for comment regarding its exit from the regional market.