Managed Care 101: Medicaid Managed Care Status Update

Managed care is certainly a hot topic in our state. As we’ve discussed in previous posts, Kentucky has undergone major changes to its Medicaid program since 2011 by bringing in multiple private companies to run Medicaid in order to save costs. This new system is called Medicaid managed care. The transition has been anything but easy, and it looks as if the road will remain bumpy for awhile longer.

The House Budget Review Subcommittee on Human resources met on February 6, 2013. The agenda was dedicated solely to managed care in Kentucky, from the viewpoints of the Department of Insurance, the Department for Medicaid Services, the Cabinet for Health and Family Services, and the managed care companies.  While the basics of the system were the focus of the conversation (the meeting was nicknamed “Managed Care 101” by Committee Chair Representative Lee), many noteworthy themes emerged from the dialogue.

It’s clear that Medicaid providers in the Commonwealth are experiencing difficulties with getting paid for services they provide to Medicaid members. The managed care companies have to send quarterly reports to the Department of Insurance with detailed information on submitted and paid claims. However, the quarterly reports have information on them from many months earlier. For example, the managed care companies had to submit a report to the Department of Insurance on December 31, 2012 with information on claims from April-June 2012. This means that if a managed care company did not pay claims in a timely manner as outlined in their contracts from April-June 2012, the Department of Insurance might not have known about it until December 2012. You don’t have to be a member of the Committee, or even schooled in health policy to know that six months is simply too long for an unpaid claim to go unaccounted.

When discussing the efforts made on behalf of the Cabinet, Secretary Haynes reminded everyone that the transition to Passport managed care in the Jefferson County area in 1995 wasn’t without problems, and many of those issues were similar to those of the present. The Secretary is ready and willing to provide assistance to any providers having trouble with claims issues. She even publicly announced that providers may call her directly for help in settling discrepancies with the managed care companies.

While each managed care representative discussed various managed care topics including reasons for rejected and denied claims, electronic filing of claims continued to be a key point brought up in discussion. According to each representative, electronic filing and payment of claims is the fastest way to get claims through the system. However, only a small percentage of providers file claims and receive payments electronically. If more providers would sign-up for electronic payment, the problem of payment delay could be minimized.

I have corresponded with multiple providers who have expressed sincere frustration over the managed care procedures and processes. In some cases, health care providers are hiring more office workers to keep up with paperwork, and in the worst cases, health care practices are closing because they are not getting paid for services they provide. The fact remains that Medicaid managed care in the Commonwealth needs to improve soon to ensure health care access and quality to the thousands of kids who are insured through Medicaid in our state.

So, what can be done to fix these problems? While the issues are complex, we can make this system better. Kentucky Youth Advocates is preparing a report outlining several recommendations for improving managed care which will be released this spring. We want to do more than just talk about the problems, we want to be part of the solution…so, stay tuned.

 

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