400 Kansas City kids lose hospital coverage

Children’s Mercy Hospital will be out of network for approximately 400 patients in the Kansas City area who purchased insurance through the Affordable Care Act marketplace starting January 1. The change leaves many families without a primary pediatric hospital, forcing them to seek new providers or pay higher costs for the care their children already require.

The hospital announced the decision this week, noting that the move is tied to the departure of Medica, an ACA insurer, from specific counties in Kansas and Missouri. Medica is leaving Johnson and Wyandotte counties in Kansas, as well as Jackson, Clay, Johnson, Lafayette, Platte, and Ray counties in Missouri. Patients in those areas with Medica plans will lose access to the hospital’s main facilities and its 31 associated pediatric clinics. Those with employer insurance, Medicaid, Medicare, or TRICARE are not affected.

Christy Moreno, a single mother of two in the metro, says the news has made her question whether she should sell her home and move. Her 16-year-old daughter sees specialists at Children’s Mercy frequently, and Moreno currently pays nearly $1,950 a month for a household plan. She has taken on three jobs and secured a home equity loan to cover past medical debts. "It seems like it's so hard for families like mine who don't qualify for any type of government subsidy, but at the same time we are struggling," Moreno said.

Kasey Jackson, a Leawood resident whose 13-year-old son is undergoing cancer treatment for acute lymphoblastic leukemia, feels the hospital needs to provide more clarity. Her son is halfway through a two-year treatment plan at Children’s Mercy, which she describes as the only option for his care in the region. Jackson said her family donates to the hospital and participates in its fundraising events. "We don't want to call Children's Mercy liars, but we also at the same time do feel like we deserve answers to understand what actually happened behind the scenes with these contracts," Jackson said. Her social media post about the situation gained attention from celebrity educator Ms. Rachel.

Hospital spokesperson Lisa Augustine said in an email on October 22 that the hospital is helping families find coverage options. Augustine stated that the hospital wants to remain in the marketplace and is speaking with other insurance plans to secure network inclusion. A dedicated webpage and a phone line at (816) 302-1650 are available for questions.

Regulators in both states say they cannot force a settlement. Angela Nelson, director of the Missouri Department of Commerce and Insurance, said patients should never be bargaining chips but noted there is no easy resolution. Holli Kroeker, director of communications for the Kansas Department of Insurance, stated that the federal Centers for Medicare and Medicaid Services holds jurisdiction over network adequacy for these plans. Kroeker advised affected Kansans to contact the Consumer Assistance Division at 785-296-3071.

David Hawkins, a father of four near Parkville, Missouri, has switched insurance plans four times in four years to keep his children with their pediatrician. He and his wife own a business and rely on ACA coverage. Hawkins said he and his family have considered moving to a state with more insurance options if Kansas and Missouri do not provide accessible plans. "If Kansas and Missouri are not going to provide accessible plans, then maybe moving to a different state that has more options for us … it seems like a good enough reason to move," he said.