Roll-Out: Medicaid Managed Care

A big change is about take place for almost a million Kentucky families and health care providers – the expansion of Medicaid managed care, scheduled for an October 1 rollout. What this change means is that the state will no longer be managing the day to day logistics of the Medicaid program – four companies will. This will impact who families call to get their questions answered, who recruits and pays doctors, and how much money will be saved. While the idea has a lot of potential and could be a great thing, the change is putting a lot of people on edge.

State administrators are working to make sure that all the people on Medicaid have a seamless transition to this new system and they are hoping they thought of everything. The new managed care companies are scrambling to contract with as many health care providers as possible to allow for continuity of care. Health care providers are trying to figure out if and how they will be involved in this switch. Advocates are trying to help protect the members they represent from undue hardship. Policymakers are trying to make sense of the complaints they are hearing and trying to get their 2 cents in the debate.

At this point, the national experience with managed care has been both positive and negative. In some cases, managed care has produced dramatic savings and improved health outcomes. In other cases, the reverse has occurred, and the cost-saving strategies used by managed care companies have compromised the well-being of plan members by making it more difficult to navigate an already complex health care system.

Kentucky can’t afford to move backwards in health. Most people know the negative stories about our state’s health – high obesity rates, bad teeth, too many low-birthweight babies, too much smoking.  And, new Census data released this week revealed that 1 in 6 people in Kentucky have no health insurance. Given this reality and the impending changes with managed care, we need to ensure that 1) health outcomes are improved 2) families are not dropped from Medicaid and KCHIP and 3) quality of care is not only upheld but improved.

In the coming year, KYA will work with partners on the 2012 Blueprint for Kentucky’s Children Agenda to ensure that children’s health is prioritized through managed care implementation by monitoring issues such as utilization of school based health services, enrollment and retention in KCHIP, quality of care, and access to providers.

We have heard some quibbling from the candidates for Governor on whether projected cost savings are feasible. The cost factor is important to be sure. But our question is, “How will the shift to managed care impact children and families?” Will their well-being see an improvement or a regression? The change is coming. That means we need to begin asking our candidates about their plan for protecting Kentucky’s children and families.

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