Issues between managed care companies and Kentucky Medicaid providers still mar the state’s implementation of the program

By Molly Burchett
Kentucky Health News

For many health care providers in the state, implementation of Kentucky’s Medicaid Managed Care system has been taxing, but Cabinet for Health and Family Services officials say the state is taking steps to resolve disputes between these medical providers and managed care organizations.

Despite previous attempts by state officials to address these issues, providers like Sen. Danny Carroll, chief executive officer of Easter Seals West Kentucky, an organization that provides care for disabled adults and youths, continue to complain about both delayed or denied Medicaid payments and burdensome bureaucratic hurdles, Kevin Wheatley reports for cn|2‘s Pure Politics.

Carroll, a Paducah Republican who chaired Thursday’s legislative committee meeting, is not alone. Other nonprofits and providers serving the Medicaid population say they are still struggling to stay financially viable and deal with managed-care organizations that are not state-based and that have different rules.

“It’s very frustrating trying to navigate the rules of all the different MCOs and all the different requirements, and it’s taxing on staff, it costs more money,” Carroll said. “Being a nonprofit, we need those funds to operate, and we’re having to focus more and more on how to navigate the system to get prior authorizations approved. One MCO requires a prior authorization every 60 days. Some it’s longer, and the rules have changed fairly frequently over the last few years,” said Carroll.

Medicaid Commissioner Lisa Lee

Lisa Lee, commissioner of the Department for Medicaid Services, told the legislative panel that the state has attempted to resolve many of those criticisms in new MCO contracts that took effect July 1. These efforts included provisions like “requiring standardized forms for all five managed care groups, utilizing national uniform standards to credential health professionals and adding stiffer penalties for non-compliance,” Wheatley reports.

Lee noted that Medicaid has 1.2 million members “and we have thousands of providers, and I know that we do have some issues and when we have those issues, they seem to be bigger than what they are. But we are able to do provide many services that were not provided by the traditional fee-for-service model,” citing one MCO that sent a case worker to the emergency room at midnight to help one Kentuckian during a crisis situation.

Carroll and others on the committee complimented the cabinet for its work to resolve issues between providers and MCOs, but Carroll said he wished the state had greater oversight of MCOs.

He cited one Medicaid provider who has seen an increase in the percentage of Medicaid patients in his practice and has had to borrow money to make payroll: “So you tell me, is the system working under those circumstances?”

Such questions are part of the overall discussion of Medicaid expansion and the millions of dollars it may cost the state as the federal dollars decline, said Carroll. The state will begin paying a portion of expansion expenses in 2017, when the federal government will cover 95 percent, decreasing to the federal health reform law’s floor of 90 percent in 2020.

Lee said the Medicaid expansion has put $2 billion into the state’s economy and “has been very positive because we know that a dollar’s not spent once,” she said. “The Medicaid program pays the providers, the providers pay their employees, their employees go to the grocery store, they go spent that money in other ways out into our economy.”

However, if fewer providers are available to Medicaid patients because of managed care, regulatory requirements and low Medicaid reimbursements, critics say the Medicaid expansion won’t give people the care they need and will be a continuing burden on hospital emergency rooms.

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