Legislators question if Medicaid is ready for managed care

“State lawmakers on Thursday questioned whether the state has the resources and expertise to oversee moving the $6 billion Medicaid program to private, for-profit managed care companies,” Beth Musgrave of the Lexington Herald-Leader reports.

Staff of the Interim Committee on Program Review and Investigations, chaired by Republican Sen. Jimmy Higdon of Lebanon, left, reviewed reports and found state Medicaid staff did not adequately analyze their current program to determine if there were savings or if there were waste and abuse. These reports “quite frankly, have us concerned that the cabinet is not fully prepared” to switch to and monitor managed care by July 1, as per the deadline, Higdon said.

In testimony, officials with the Cabinet for Health and Family Services told lawmakers they do feel they have the expertise to handle managed-care contracts. Neville Wise, acting Medicaid commissioner, said part of the contract monitoring will be done by an independent contractor. He did not say the cabinet would be ready to implement managed care by July 1.
Sen. Vernie McGaha, R-Russell Springs, also asked cabinet officials how they will assess whether managed-care organizations save the state money once they are implemented en masse. The cabinet could not determine if the only managed care organization already in place, Passport Health Plan in the Louisville region, saved the state money. That was one of the weaknesses pointed out in a highly critical audit by state Auditor Crit Luallen.
Moving to managed care is the centerpiece of Gov. Steve Beshear’s proposal to fill a $166 million gap in the Medicaid budget. Senate President David Williams, R-Burkesville, says he is unconvinced. Williams is running against Beshear for governor in the Nov. 8 election. (Read more)
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