Eight Months into Medicaid Managed Care

The numbers of children enrolled in Medicaid and the Kentucky Children’s Health Insurance Program (KCHIP) are on the rise, we learned in yesterday’s post. This data helps us understand how many children live in families who do not earn enough income to afford health insurance. The Medicaid program and KCHIP provide health insurance and access to health care for children in low-income households, in order to strengthen their health and future.

One thing those numbers don’t yet show us is what’s happening at the state level with Kentucky’s Medicaid managed care system. As we’ve mentioned in previous blog postings, Kentucky moved to a statewide Medicaid managed care system in November 2011. That basically means we gave 3 for-profit companies, CoventryCares, Wellcare, and Kentucky Spirit control of our public programs that provide health care coverage for low-income children and families in Kentucky.

We are now 8 months into the new managed care scenario. How has the transition been going? Well, take a look at some of the latest headlines on managed care:

  • “Appalachian Regional Healthcare files a lawsuit against the Cabinet for Health and Family Services and two of the three managed care companies, CoventryCares and Kentucky Spirit for failing to pay promptly;”
  • “CoventryCares is making doctors renegotiate their contracts for lower rates;”
  • “The Cabinet for Health and Family Services is refusing to release reports from the managed care companies, claiming the information is proprietary;” and
  • “Kentucky dentists are dropping out of the Medicaid program altogether.”

What does this really mean for people on Medicaid right now? Let’s break it down:

  • While the managed care companies and the Cabinet for Health and Family Services deal with lawsuits, there is less time available for improving the quality of patient care and access to care;
  • Cancelled contracts with providers mean fewer choices for people on Medicaid when they are trying to find a doctor near home;
  • Not releasing the managed care reports results in a lack of transparency which makes it hard to assess how the new system is doing; and
  • Frustrated dentists who stop accepting Medicaid means the already large gap in access to dental care is growing in Kentucky.

This seems somewhat depressing, but there is hope. Kentucky Auditor Adam Edelen created a special unit to monitor Medicaid managed care and plans to audit the managed care companies this year. This is a huge step toward holding them accountable. The state also created a new oversight branch for managed care which will help ensure the managed care companies honor their contracts. But only time will tell if these measures truly improve the system.

While those are all things moving us in a better direction, when will we start hearing about improved patient outcomes? When will we learn about the child with diabetes who finally gets his symptoms under control with the help of a case manager? When will we see that the little girl on 10 different medications was able to get down to only 2? And when will we hear that patient care is the priority instead of the bottom line of profit? I still have hope. I try to be optimistic. But in order for this to work, the managed care companies can’t just focus on making a profit. The state must hold the managed care companies accountable. And we must all work together for the common goal of improving the health of Kentucky’s most vulnerable children and families.

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