UPDATE, January 8, 2019: Following its sale to Centene, Fidelis said on its website that as of January 1 it will directly cover reproductive health services including birth control, emergency contraception, sterilization, pregnancy testing, HIV and STD testing, and “abortion that you and your doctor agree is needed.”
If Fidelis Care is sold, 1.7 million New Yorkers enrolled in the Catholic health insurance company will no longer have their reproductive health access curtailed by the Catholic Church.
Fidelis, one of the most dominant insurers on New York’s state-run exchange, refuses to cover abortion care, sterilization, and most forms of contraception under the Catholic Ethical and Religious Directives, outsourcing reproductive health care coverage to a third-party insurer for many of its members. These members encounter a bureaucratic obstacle course when trying to obtain contraception, as a Rewire.News investigation last year revealed. (The third-party insurer, Unified IPA, says in its benefits plan for this year that it covers “medically necessary abortions including abortions in cases of rape, incest or fetal malformation,” but only covers one “elective” abortion each plan year.)
The restrictions would end if the New York attorney general’s office approves the sale of Fidelis to the for-profit Centene Corporation.
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“In terms of reproductive health coverage, I think the sale of Fidelis to Centene is a win for the women of New York,” Lois Uttley, who has researched Fidelis for at least a decade, told Rewire.News.
It’s unclear exactly when Centene would lift the restrictions.
A document outlining the terms of the sale says that for one year after the closing, Centene will “use commercially reasonable good faith efforts to comply with the protocols and policies developed by [Fidelis]…relating to the Ethical and Religious Directives.”
But Uttley said that during a meeting with health advocates late last year, Centene executive Chris Koster assured her the company would lift the restrictions as quickly as possible. “It was my impression that it would take place by the end of this year, assuming the transaction went through in 2018,” Uttley said.
Centene did not respond to questions about the timeline.
“Once the transaction is finalized, Centene will follow the instruction of New York regulators on all issues,” a spokesperson said in an emailed statement.
The New York attorney general’s office, which is reeling from the resignation this week of Attorney General Eric Schneiderman following reports he physically and psychologically abused women, did not respond to questions about whether it would require Centene to meet any conditions for reproductive health coverage. New York’s Department of Health and Department of Financial Services (DFS) have both approved the sale.
In an emailed statement, New York Financial Services Superintendent Maria T. Vullo said DFS has “advised both Fidelis and Centene that, if the acquisition transaction is approved and executed, all of the coverages required by New York and federal law, and DFS regulations mandating contraceptive and abortion coverage, must be provided directly by [Centene].”
The attorney general’s office has invited the public to comment on the sale by May 23.
While the deal may be a win for reproductive health, Uttley said she is concerned about how Centene, a for-profit corporation, has been fined in Washington state for failing to maintain an adequate network of medical providers. Centene is the largest Medicaid managed care organization in the United States, its website says. Fidelis is New York’s largest Medicaid managed care provider, and has the largest market share in the state for the Essential Plan, for New Yorkers with low incomes, and qualified health plans on the individual marketplace.
Uttley says advocates will be watching to ensure that Centene includes an adequate number of reproductive health providers in its network. She will also watch to see how the Catholic hierarchy in New York uses the proceeds from the sale of Fidelis. Much of the billions in annual revenue Fidelis earns has come from public funding via Medicaid.
While the state will receive $2 billion from the sale, another $3.2 billion will go to the creation of a health foundation “born of our Catholic tradition of healing for the sick and caring for the poor,” New York Archbishop Timothy Dolan announced on Tuesday.
The Mother Cabrini Health Foundation will be one of the largest charities in New York City and the largest dedicated entirely to causes in the state, rivaling the Carnegie Corporation of New York in size, according to Crain’s New York Business.
Uttley said it would be disappointing if the foundation chose, for example, to funnel that wealth into anti-choice crisis pregnancy centers, or fake clinics, as other Catholic-affiliated foundations have done.
A spokesperson from a public relations firm handling requests about the foundation refused to answer questions about whether its grant-making decisions will be guided by the Catholic hierarchy’s opposition to abortion rights, contraception, and LGBTQ health care.