Providers push back on accelerating benefits management model

YARMOUTH, Maine – Molina Healthcare’s plan to use CareCentrix and its DME Navigator solution in four states is drawing criticism from home medical equipment (HME) stakeholders, who say the model significantly reduces reimbursement, threatens patient access to care and adds unnecessary administrative layers.

Molina Healthcare has selected CareCentrix – which developed DME Navigator with OptumInsight – to manage all lines of business effective June 1, 2026, in Illinois, Washington state, South Carolina and Ohio. It plans to expand to all 18 states it serves, according to the Midwest Association of Medical Equipment Services (MAMES).

‘Take it or leave it’ contracting approach

Providers report that CareCentrix is offering rates that are 50% to 60% lower than current Medicare and state Medicaid rates to serve Molina Healthcare’s members.

 “There's not a good faith in negotiation happening,” said Bryce Schaffner, vice president of business development for Bellevue Healthcare in Washington and president of the Pacific Association of Medical Equipment Services (PAMES). “It’s kind of take it or leave it, and for providers there's not more room to give.”

Independent providers – and local access – at risk

Steep cuts to reimbursement often lead to very narrow networks, squeezing out small, independent providers, says Eric Blake, chief compliance officer at Shriver’s Pharmacy/Home Medical Equipment in Zanesville, Ohio, and president of the Ohio Association of Medical Equipment Services (OAMES).

That dynamic could force patients to switch providers – if they can find one. In Ohio, the number of DME suppliers has declined by 46% since 2013, Blake says.

“Patients with complex products like ventilators, oxygen, complex rehab – they build relationships with their local supplier,” he said. “Those local suppliers are the ones that have taken care of them in emergencies.”

Added administrative burden

Providers say payers may look to benefits managers and third-party administrators to improve coordination, but they’re often just introducing new layers between providers and patients that can complicate service delivery.

“Operationally, we are seeing increased administrative demands,” said Garrett Moody, vice president of payer strategy for DASCO HME, which is based in Westerville, Ohio. “Processes that were once handled directly with payers now require navigating intermediary platforms, adhering to additional documentation standards, and managing more frequent authorization requirements. These steps can slow down order fulfillment, delay patient care, and require ongoing staff training to remain compliant with evolving protocols.”

Frustration over communication

In the ramp up to the June 1 effective date, however, stakeholders say communication with CareCentrix has been limited.

“Many providers have reached out, or tried to, and they just really get nowhere,” said Barb Stockert, executive director of PAMES. “In fact, there were a couple of our suppliers or members that didn't even know that this was happening.”

Providers call for collaboration

If payers are serious about keeping costs down, while ensuring patients maintain high-quality care, HME providers need to be involved earlier in the process, says Joel Gallion, CEO at Bellevue Healthcare.

“I do believe that there is a way to do that, but I don't believe the current methodology is it,” he said. “They are making it strictly about who will take the lowest fee schedule. We saw that almost a decade ago with competitive bidding. And we really saw how that ended for a lot of providers. It doesn't end well. It doesn't end well for access. It doesn't end well for patients and, ultimately, it doesn't end well for providers.”

No additional comments

CareCentrix said it had no additional comments on its contract with Molina Healthcare but pointed to previous comments to HME News including, “Our priority is ensuring members receive the right care, at the right time, with exceptional service quality.”

Molina Healthcare did not respond to a request for comment.

Related reading

• Are any of your payer partners already using or currently transitioning to a benefits manager / third‑party administrator (TPA) model to manage DME benefits? Take our HME Newspoll. 
• Providers in Tennessee also recently learned that BlueCross BlueShield (BCBS) of Tennessee was shifting to CareCentrix to manage its commercial, Medicaid and Medicare Advantage plans.