NY Lawmakers Call for Health Department Review of Optum's Network Changes

Two New York state lawmakers, Senator Peter Harckham and Assemblyman Matt Slater, have urged the New York State Department of Health to investigate UnitedHealth Group's physician practice division, Optum, amid concerns over recent network plan exclusions and clinic closures. The lawmakers seek an examination of whether Optum's exclusion of competing exchange plans poses a conflict of interest. They also recommend implementing regulations that mandate advance public notification before major clinic closures to ensure transparency and prepare affected communities. Recently, Optum discontinued several insurance plans, including Fidelis/WellCare and Cigna/HealthSpring, potentially affecting coverage for low-income individuals, Medicare Advantage enrollees, and Medicaid recipients. Additionally, Optum is closing a multispecialty medical office in Somers, New York, which raises questions about healthcare access and affordability in the region. In response, Optum highlighted the financial pressures resulting from reductions in Medicaid funding, prompting adjustments in payer relationships in New York and New Jersey to maintain affordable care. The company emphasized ongoing evaluations of services, facilities, and staffing to align with market dynamics and care delivery needs. Elizabeth August, MD, Optum Medical Care’s associate chief medical officer for New York and New Jersey, has publicly addressed challenges related to federal funding cuts for Medicare and Medicaid, advocating for enhanced collaboration and innovation among healthcare providers. These developments underscore regulatory and market shifts impacting network configurations, payer/provider relationships, and patient care access within Medicaid and Medicare segments. The situation exemplifies broader industry challenges of balancing cost containment with service availability amid evolving healthcare funding landscapes.