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Highlights • Highmark Health Plans

For the underserved in Delaware and West Virginia: Health coverage to count on

When the Affordable Care Act granted states the option to expand their Medicaid programs to more Americans, Delaware and West Virginia stood up and said "yes" on behalf of their underserved residents. Under the expansion, many more people would be able to access long-needed, often long-delayed services including preventive care, treatment for chronic conditions, behavioral health care and dental care.

At the same time, for the states, expanding posed a significant challenge. They needed reliable, experienced partners who could quickly stand up the expanded programs.

Highmark Inc.'s affiliates were already there, serving those states—providing reliable Blue Cross Blue Shield health plan coverage to individuals, families and businesses in the commercial and government markets. Expanding into Medicaid was a natural progression. Highmark health plans answered the call.

Today, Highmark companies are serving 155,000 new members and counting through Medicaid programs in the two states. In Delaware, where more than 20 percent of the residents rely on Medicaid, Highmark Blue Cross Blue Shield Delaware is one of only two insurers that stepped in. Highmark Delaware's subsidiary, Highmark Health Options, began serving the state on January 1, 2015, creating more than 100 jobs in the process. Throughout the year, the program grew quickly to serve more than 100,000 people—many of whom are low-income children with special needs.

In West Virginia, about 30 percent of the population relies on Medicaid. Here, an innovative partnership took shape, with Highmark Blue Cross Blue Shield West Virginia leading a collaboration that established West Virginia's only provider-sponsored network, called West Virginia Family Health (WVFH). This type of network enables Highmark West Virginia and the providers to work closely together to advance case management, medical care and wellness programs that lead to a better patient experience and better health outcomes. The WVFH's owners include 22 Federally Qualified Health Centers, two primary care clinics and the West Virginia Primary Care Association, which collectively serve more than 54,000 members in the state.

"At Highmark, getting health care right has always meant providing coverage to as many people as possible," said Jean Rush, executive vice president of government markets for Highmark. "Our goal is for those we serve to experience better care and better overall health during their lifetimes. We are working with our new Medicaid members to help accomplish just that for them."


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