Maine’s Congressional Delegation Seeks Special Enrollment Period for Medicare Advantage Patients Impacted by Northern Light/Humana Split

Maine’s Congressional delegation has sent a letter to the Centers for Medicare and medicaid Services (CMS) urging the creation of a special enrollment period for Humana Medicare Advantage beneficiaries impacted by Northern Light Health terminating its contract with the Medicare Advantage provider.

As of September 30, Northern Light Health — one of the largest medical service providers in the state — ended its Medicare Advantage contract with Humana after “considerable time and effort” was spent “try[ing] to resolve numerous ongoing administrative issues,” according to an August press release.

This decision was estimated to have impacted between 2,000 and 4,000 patients in Maine, many of whom are likely to be from more rural parts of the state, given the nature of the area primarily served by Northern Light Health.

Consequently, many of those affected may now have to either travel great distances to receive in-network care or, in some cases, forgo care altogether.

[RELATED: Mainers Brace for Higher Out-of-Pocket Costs as Northern Light Health Ends Medicare Advantage Contract with Humana]

Special enrollment periods (SEPs) are provided by CMS to patients who have experienced certain life changing scenarios, such as moving, losing healthcare coverage, or having a baby.

The delegation urges CMS to offer SEPs to those impacted by Northern Light’s contract termination “given the significant strain this decision puts on a large number of constituents who seek care at Northern Light Health.”

While patients currently cannot obtain new coverage until January 1, 2025, an SEP would allow new plans to take effect as soon as November 1, providing an additional 60 days worth of coverage and “limiting further disruptions in care.”

“An SEP would help those affected patients continue to seek treatment from their current doctors with minimal disruption in coverage,” wrote Sens. Susan Collins (R) and Angus King (I), as well as Reps. Jared Golden (D) and Chellie Pingree (D).

“It is our understanding that Humana has shared recommendations for alternative in-network hospital sites of care with [Northern Light Health] patients, but such alternatives pose additional challenges,” the delegation continued. “For example, of the seventeen facilities to which our constituents are being directed, only two are a mile or less away from the current [Northern Light Health] facility. The vast majority of suggested alternative in-network facilities are at least 20 miles away, with some as far as 50 miles and one nearly 100 miles away.”

“Furthermore, these alternative facilities may not have the capacity to take additional patients,” they said. “Maine is a large rural state, and access to emergency, acute, or in-patient care can be challenging.”

“The Humana-[Northern Light Health] contract termination represents a significant change to the plan provider network, affecting thousands of Mainers,” the delegation concluded. “We urge CMS to use its existing authority to authorize an SEP for all Maine [Medicare Advantage] beneficiaries affected by this change.”

Click Here to Read the Delegation’s Full Press Release

In an August statement to WABI, Humana said that they “remain open to further good faith discussions with Northern Light Health regarding continued participation in [their] network so that” disruption can be avoided.

“At the same time,” they said, “we must ensure our contracted hospitals and physicians provide both quality and cost-effective care to keep health coverage costs as affordable as possible for our members.”

By the end of 2023, Northern Light reportedly had an operating deficit of $36 million, a promising upturn from the 2022 deficit of $132 million. So far in 2024, however, they appear to have already incurred a $60 million deficit.

Northern Light Health has reportedly responded to financial and operational difficulties in a number of ways, including reducing hours for their Bangor walk-in clinic, closing its audiology center, altering the provision of ambulance services in seven Penobscot County towns, and closing its Internal Medical facility in Dexter.

According to the Bangor Daily News, Northern Light’s workforce decreased by about 1,500 employees between 2021 and 2023.

Changes in federal funding have also reportedly had an impact on Northern Light’s ability to effectively provide services, as much of the pandemic-era funding has since dried up.

Suzanne Spruce, a spokesperson for Northern Light Health, has previously said that 66 percent of the organization’s services are provided to Medicare and Medicaid patients.