Outside Medicaid Managed Care Company Attempting to Gain Foothold in Louisville

State officials have not yet given private Medicaid operators permission to do business in the Louisville area, but that hasn’t stopped one company from trying to make inroads. Currently, Passport Health Plan runs Medicaid in and around Louisville. The federal government has ordered the state to open the region to competition, but the area remains […]

Appalachian Regional Healthcare Ordered to Discuss Issues With Medicaid Operator

A federal judge has ordered Eastern Kentucky’s largest healthcare provider and one of its major Medicaid operators to talk through their issues before appearing in court this week. Appalachian Regional Healthcare (ARH) filed suit last month against CoventryCares, which is one of four private Medicaid managed care operators (MCO) in Kentucky. Last year, the state privatized Medicaid […]

Healthcare Provider Sues Medicaid Care Operators

The main healthcare provider for eastern Kentucky, Appalachian Regional Healthcare, has filed suit against two of the state’s four Medicaid managed care operators. In complaints filed this week, Appalachian Regional Healthcare alleges Coventry Health and Kentucky Spirit Health Plan owe the provider over $17 million in back payments. Kentucky privatized Medicaid statewide last November to […]

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 […]

Bill to Create Statewide Fraud Law Is Re-Introduced

A bill that would allow Kentucky to collect money from Medicaid fraud busts has again been introduced in Frankfort. House Speaker Greg Stumbo filed the bill, which would also protect and possibly reward whistle blowers who report fraud in Medicaid or any other areas of state government. Stumbo says the bill is needed to help […]

Managed Care Executives Say They’ve Fixed Problems With Payments

Officials with Kentucky’s Medicaid managed care organizations say they’re on track to resolve any problems with reimbursements to doctors and pharmacists. CoventryCares, WellCare and Kentucky Spirit began administering Medicaid statewide last fall, and they’re off to a rocky start. Executives with the three organizations are in Frankfort this week for a series of committee hearings. Doctors, […]

Managed Care Organizations Say Reimbursement Problems Are Resolved, But Pharmacists Disagree

Kentucky’s Medicaid Managed Care Organizations say they have fixed a number of issues with reimbursements to pharmacists. CoventryCares, WellCare and Kentucky Spirit took over management of the state’s Medicaid system last year. Since then, doctors and pharmacists have come forward to say the organizations are poorly managed and the reimbursements for care are too low. […]

Medicaid Providers Complain of Managed Care Mismanagement

Kentucky’s private Medicaid providers say they need immediate changes in the state Medicaid system. Kentucky turned the system over to managed care providers four months ago. And today doctors, pharmacists and hospital executives told a Senate committee how disastrous the change has been. Kentucky currently contracts with four Managed Care Organizations, known as MCOs. Passport […]

Louisville EMS Program Saves Money, Provides Better Care

Nationwide, ten percent of emergency room visits are non-urgent. People call 911 or go to the hospital for ailments that could be cured at a doctor’s office or clinic. A majority of these patients are on Medicaid or are uninsured, and their ER visits drive up healthcare costs. That makes them the target audience for […]

Kentucky Prepares for Switch to Privatized Medicaid Care

Kentucky’s three new managed care operators, MCOs, say they’re ready for members to switch over to privatized Medicaid care this week. The switch on Nov. 1 is expected to save the state around $375 million over the three year contracts while managing patient care more efficiently. The change was previously scheduled for Oct. 1 but […]