The Detroit Medical Center and Children’s Hospital of Michigan state thousands of southeast Michigan residents enrolled in Centene health plans could lose in-network access as early as Jan. 1, 2027, if the entities fail to reach a contract agreement before year’s end.
Nationally, more than 13 million patients and their families stand to lose in-network access to Tenet Healthcare hospitals and doctors like DMC and Children’s Hospital of Michigan by January 1, if Centene, the country’s largest Medicaid managed care organization, follows through on its recently issued contract termination notice, those close to the negotiations say.
Roughly 70 percent of the Centene members who rely on local Tenet hospitals and doctors are Medicaid enrollees, and in southeast Michigan, about 120,000 existing Centene Medicaid and Medicare covered plans may be affected. This includes patients who receive insurance coverage through Centene’s Health Insurance Exchange (HIX), Medicare Advantage, and Managed Medicaid plans.
Talks between Tenet and Centene have been ongoing, but the two sides have yet to come to an agreement. Termination will take effect on Jan. 1, 2027 — the same day new coverage begins for patients who select Centene plans during open enrollment, which runs through Dec. 7 for Medicare Advantage and Nov. 1 through Dec. 15 for HIX.
The timing means consumers who enroll in Centene plans this fall may believe they are signing up for coverage that includes their oncologist, cardiologist, surgeon, or children’s hospital, only to discover on January 1 that those providers are no longer in-network.
“We are working overtime to get this deal done for our patients, but Centene’s current offer is nowhere near what it takes to deliver the high-quality health care that our patients deserve and have come to rely on,” says Brittany Lavis, Group CEO of Detroit Medical Center and Children’s Hospital of Michigan.
“We have seen too many cases where Centene has let these contracts expire, putting immense stress on patients and families who just want to keep their doctors and to know they can afford their medical bills.”
The stakes for vulnerable patients are especially high. Without an agreement, patients enrolled with Centene could face disruptions to their existing treatment plans and higher out-of-pocket costs once their provider moves out of network.
Medicaid members have fewer health care insurance alternatives and the least financial resources to absorb the potential cost differences, according to officials.
Tenet officials state its original contract proposal would have cut hospital reimbursement rates to well below-market levels. When the proposal was rejected, Centene immediately followed with a termination notice, threatening millions of patients’ access to care.
Tenet has called on Centene to resume negotiations with a revised offer, one that is necessary to sustain quality care.
Medicaid advocates and hospital industry groups have urged both parties to reach a resolution before open enrollment concludes in December, warning that a Jan. 1 contract termination would leave newly enrolled members without the in-network access they expected when they selected their plan.
In the interim, Tenet recommends patients should contact their health insurer to confirm the plan they choose will include in-network access to their preferred local doctors and hospitals.
