Frankfort Local News

Edelen Says He’ll Audit Private Medicaid Operators This Year

After months of mounting problems, State Auditor Adam Edelen says he will launch a full investigation intoKentucky’s statewide Medicaid Managed Care system.

Edelen created a Medicaid task force in February after taking a first look at the managed care system. He also gave recommendations to managed care companies, health care providers and the state on how to make the system run better in the future.

But with clashes between private Medicaid companies and healthcare providers ongoiong, Edelen wants to take a stronger look into the system.

“We will launch a full blown audit of the managed care companies based on the information that’s being gathered right now, we’re going to launch that investigation by the end of the year,” he says.

Frankfort Local News

Denton Has Concerns About More Private Medicaid Operators in Louisville

The problems with privatized Medicaid in Eastern and Western Kentucky could be coming to Louisville.

Passport Health Plan has run Medicaid in Louisville and the surrounding area for more than a decade. The system was the model for last year’s Medicaid privatization, which brought three new Medicaid management companies into the state.

The federal government has ordered the state to open the Passport region to competition by next year. But Medicaid privatization isn’t working too well in the rest of the state. Hospital officials claim two of the private companies aren’t paying enough to reimburse Medicaid-covered care. The private operators say they are only adhering to their contracts with the state.

“Let’s make sure we have a plan,” says Senate Health and Welfare Committee Chairwoman Julie Denton. “If we are going to be bidding out with the Passport region for next year, starting January 1st, the Cabinet sure as heck better be working on an RFP and putting it together in a more thoughtful and steady fashion than they did the Medicaid managed care RFP for last year.”

The state has until July 1 to tell the federal government its plan to open Louisville to competition. But the Cabinet for Health and Family Services hasn’t yet begun work on the plan.

The current three statewide operators all have offices in Louisville, making them obviously competition partners for the region. But Denton says she’s not sure bringing those three in is a good idea.

“I don’t think they can just take three bids from the three MCOs and open those up and let those three MCOs in. And frankly with the way Coventry has been working thus far, I have no interest in letting them into the Passport region,” she says.

Currently, many healthcare systems are having contract issues with CoventryCares, one of the three new statewide MCOs. Coventry officials say they need more operating money and the company is looking to providers and patients to recoup profits.  That has led to lawsuits and threats from lawmakers that Coventry could be barred from operating in the commonwealth.

Frankfort Local News

Denton Says Lawmakers Will Remove CoventryCares From Medicaid System if Tough Bargaining Continues

Kentucky Senator Julie Denton says the state’s largest private Medicaid company is underpaying and threatening healthcare providers, and she says lawmakers may kick the company out of the state Medicaid system if the behavior persists.

CoventryCares is one of three new private Medicaid Managed Care Organizations (MCOs) that began business in the commonwealth last year. But problems with the privatized system popped up quickly. They began in Eastern Kentucky. Hospital chain Appalachian Regional Healthcare sued Coventry for making inadequate and late payments to hospitals for care that should be covered by Medicaid. Coventry officials say they’re operating within the new state rules for private Medicaid operators. The two sides are in contract talks now, but the problems have spread. This week Coventry told Baptist Health Systems in central and western Kentucky that it will stop payments immediately after their current contract expires in September unless a new deal is worked out in advance. 

Coventry and the other new MCOs, Kentucky Spirit and WellCare, are losing money. Denton, who is chairwoman of the Senate Health and Welfare committee, says that’s because they received bad information from the state Cabinet for Health and Family services when they signed contracts last year. That misdirection has led Coventry to hard bargaining in contract talks. But as talks continue, Denton says costs are being passed on to patients and providers.

“It is ridiculous for Coventry to think that they can go to Appalachian Regional Healthcare and Baptist Health Systems and basically hold them over a barrel saying you’re going to take what we give you or we’re not going to play in your sandbox,” she says.

Denton says Coventry took a risk by joining Kentucky’s rushed system and the company should find other ways to make profits or risk being kicked out of the system.

“Something’s got to be worked out and if Coventry can’t work it out, I would anticipate the legislature would move, if the Cabinet does not move, to eliminate Coventry from participating in Medicaid in Kentucky,” she says.

Lawmakers were hesitant to act to correct any problems during this year’s session because they wanted to give the system time to work. But Denton says things are not getting better.

Governor Steve Beshear proposed the managed care system as a way to shore up the Medicaid budget, which is normally one of the state’s heaviest financial burdens. Despite the problems, Beshear says the system will eventually work.

Frankfort Local News

Lawmakers Take Medicaid MCOs to Task for Not Solving Pharmacy, Mental Health Care Issues

Kentucky lawmakers continue to chastise three of the state’s Medicaid Managed Care organizations for mismanagement.

Representatives of Kentucky Spirit, Wellcare of Kentucky and Coventry Cares appeared before the program review committee today. Legislators wanted to know whether they had solved problems brought up by health care providers in a January committee meeting.

The MCOs all said the problems were mostly solved and that operations were improving every day. But independent pharmacists and mental health care providers disagreed.

The pharmacists say things have only regressed since that first committee meeting. That didn’t please committee co-chair Representative Fitz Steele.

Frankfort Local News

Auditor Releases 10 Recommendations to Improve Medicaid Managed Care System

State Auditor Adam Edelen has released ten recommendations for a more efficient Medicaid Managed Care system in Kentucky.

For weeks, the MCOs, lawmakers, health care providers and patients have tussled over the new system, which was implemented quickly to plug a budget gap.

MCOs have promised lawmakers that the majority of problems are fixed, but some areas like pharmacy and mental health, are still having issues.

Rather than directly auditing the managed care organizations, Edelen instead looked into how the system was using taxpayer’s funds.