Fixing Medicaid Managed Care – Governor Beshear Steps Up to the Plate

Last Friday, Governor Beshear vetoed HB 5, a bill that was intended to address issues of prompt payment to health care providers by Kentucky’s managed care companies, but he released an alternative plan to address both individual and systematic problems with managed care.

In November 2011, Kentucky moved to a statewide managed care system for Medicaid, the program that provides health insurance to low-income children and parents, pregnant women and people with disabilities. You can read more about  managed care by clicking here. The transition to managed care seems to be improving, but providers have reported a rocky transition in many areas, including a delay in payments for services they provide.

The administration has taken a responsive approach in recent months to solving challenges people have raised. Even Secretary Audrey Haynes encouraged people to call her personally if they hit a wall so she could help get the issue addressed. While the Governor vetoed HB 5, he continued that approach of trying to get issues resolved by also releasing a plan to address the issue of prompt payment. He stated concerns with HB 5, but his plan suggests an acknowledgement of prompt pay challenges that need to be addressed. This is a step in the right direction as the plan aims to address both individual and systematic problems with managed care.

For children and other Medicaid recipients, the issue at hand is not really whether managed care is improved through a legislative measure or through administrative action.  It is not a question of, “How?”  Instead, it is a question of, “What?”  The citizens in Kentucky deserve a health care system that is accessible, affordable and of high-quality.  So the real assessment of this action to veto HB 5 depends on the capacity of the outlined plan to get us to those goals. The Governor owns managed care – he is the champion of that approach.  That means that it is up to him – through whatever approach he chooses – to deliver on the promises made when managed care was introduced.  It’s not about process; instead, it is about outcomes. It is encouraging to see the specific actions recommended by the Governor, such as the component of HB 5 moving the review of provider complaints about prompt payment to the Department of Insurance.

Time will tell if the plan achieves the desired outcomes. This plan is the only option at this point to get things on track. In the meantime, we will continue to advocate for high quality health care for children whether that is in managed care or the health care system.

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