Americana Center World Festival celebrates cultures with music, food and wares

Written by
Photos and story
by Maggie Huber

Read More: http://www.courier-journal.com/apps/pbcs.dll/article?AID=2013306010081

Iroquois Amphitheater played host Saturday to the 23rd annual Americana Center World Festival, Where Louisville Meets the World. Hundreds sampled the festival’s music, food and wares.

With musical acts playing and dancers performing on two stages every half hour, there was plenty to stimulate the ears and eyes. For example, Mamta Subba, 18, performed a traditional Nepalese dance with her friends.

“It’s a rare opportunity to see different kinds of musicians in town,” said Alexander Udis, 28, the community garden coordinator at the Americana Center. “The festival started as a block party for the center and has grown to be the big event of the year when we not only get to advertise what we do at the center, but give a spotlight to all the nationalities that live in Louisville.”

For others, such as Lauren Humpert, “the highlight of this festival is the food,” she said as she waited for someone to cover her Fiberworks booth so she could indulge in food from one of the more than six food vendors.

Odette Nyirahuku agreed as she made beignets for her “Mama Boling” booth. Nyirahuku learned to cook the dishes at the Americana Center as part of a class. “Everybody needs our food,” she said.

Americana Community Center provides a spectrum of services based on the Louisville area’s cultural, ethnic and economic diversity.

Americana World Festival: Americana World Festival | Scenes and interviews (Video by ANGELA SHOEMAKER/Special to the Courier-Journal

Olivetta Uradu, 20, left, and Kade Tambo, 22, right, watch as a band performs on the Hilltop stage at the 23rd annual Americana World Festival at the Iroquois Amphitheater. June 01, 2013

Joyce Augustine, 10, participates in a hula hoop contest for kids during the 23rd annual Americana World Festival at the Iroquois Amphitheater. June 01, 2013

Joyce Augustine, 10, participates in a hula hoop contest for kids during the 23rd annual Americana World Festival at the Iroquois Amphitheater. June 01, 2013
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Kentucky Introduces New Health Insurance Exchange

Reported by: Aaron Adelson

Email: aadelson@wtvq.com

 

Published: 5/15 3:48 pm

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Updated: 5/15 7:20 pm

Twitter: https://twitter.com/AAdelsonABC36

As part of the Affordable Care Act, Governor Beshear announces Kentucky’s new health insurance exchange program. It’s called Kynect.

Governor Beshear says Kentucky ranks at, or near the bottom in most health statistics.  He says too many people are using the emergency room instead of seeing a primary care physician.

“This lack of early care is one reason Kentucky’s heath picture is so horrendous,” said Governor Beshear.

He says a big part of the problem is a lack of health insurance.  The Governor says about 650,000 Kentuckians are uninsured.  He says this hurts the state in a number of ways.

“A kid is not going to do better in school if they’re sick, if they don’t feel good, if they’ve got bad teeth,” said Beshear.

Last week, the Governor announced half of the uninsured will now be eligible for Medicaid.  The other half will be able to purchase health insurance through Kynect.

“There’s always that fear of the unknown.  I would refer you to Massachusetts in 2006, when then Governor Mitt Romney instituted a program very similar,” said Beshear.

You’ll be hearing a lot about Kynect.

“There will be a full scale advertising campaign,” said Beshear.

The state says 5 insurance companies plan to participate in the exchange.  The state hopes to know how much the plans will cost at the end of the month.

To learn more about Kynect, you can go to: http://kynect.ky.gov/

 

Link: http://www.wtvq.com/content/localnews/story/Kentucky-Introduces-New-Health-Insurance-Exchange/mTHSrKv4MU-YDvuA9XgGWQ.cspx

Who benefits in Louisville? Impact of the Medicaid decision

Written by
Laura Ungar

Bernice Glenn, 55, Shively

Bernice Glenn, shown with her husband, Nelson Glenn Jr., says of Medicaid expansion, ‘I won’t have to worry about how I have to pay’ her bills for medical treatment. / Photos by Kylene White/The Courier-Journal

Family: Husband, Nelson Glenn Jr., 58; three grown children.

Job, income, insurance: Bernice Glenn is unemployed, and her husband has been out of work since being injured in an accident more than a decade ago. He supports the couple with his Social Security disability payments of $1,623 a month. Bernice is uninsured.

Health issues: High blood pressure, diabetes, a nerve condition in her face, arthritis and a bad knee. She uses a cane.

Consequences of being uninsured: Although she sees a primary care doctor at Family Health Centers, she skips some preventive care. For example, she hasn’t gotten a colonoscopy to check for colon cancer, which is recommended for people when they turn 50. She also has medical bills she can’t pay.

Thoughts on expansion: “I won’t have to worry about how I have to pay these bills and how they’re going to come after me about these bills.”

Rosemary Elan, 56, South Louisville

Family: Widow.

Job, income, insurance: Elan does seasonal work for H&R Block, helping people with their taxes, but has no other income and no health insurance. She lives with her 26-year-old daughter, who works at a convenience store, earning $7.35 an hour, and also has no health insurance.

Health issues: Diabetes, high blood pressure, five cardiac stents.

Consequences of being uninsured: She has delayed getting needed care. When her heart bothered her in 2011, “I would just rub it to keep it from acting up.” She eventually needed a fifth stent and incurred $21,000 in medical bills. She said she has no way to pay: “You can’t get blood from a stone.”

Thoughts on expansion: She said she doesn’t like the health care overhaul in general, especially the penalty people would have to pay if they choose not to get health insurance. But she supports Medicaid expansion. “It would help a whole lot,” she said. “It would be a lot less strain on a lot of people.”

Job, income, insurance: She is unemployed because of illness, existing on Supplemental Security Income disability benefits for her children of about $2,000 a month. Her children have Medicaid, but she has no health insurance. She said she’s tried to buy an individual insurance policy but has been turned down because of her health.

Health issues: Jones has severe high blood pressure and a severe form of anemia, both of which have repeatedly put her in the hospital.

Consequences of being uninsured: She has medical bills exceeding $200,000 for hospital stays to treat her blood problems. She gets low-cost primary care at Family Health Centers-Portland, but stopped going to the James Graham Brown Cancer Center when she realized she couldn’t pay the bills. “After a while you get tired of it and throw your hands up,” she said.

Thoughts on expansion: “There’s a lot of people who want to go to work and just can’t because they have conditions like mine. I just think it’ll be better for people who can’t afford (care), and people who actually need it.”

Angela Kildoo, 28, western Louisville

Family: Single with three children, who are in her parents’ custody. She stays at a friend’s house.

Job, income, insurance: A former medical assistant and a temporary warehouse worker who is unemployed, with no income or health insurance.

Health issues: Thyroid problems; high blood pressure; pseudotumor cerebri, which occurs when pressure inside the skull builds up for no obvious reason.

Consequences of being uninsured: Unpaid medical bills, including a $2,000 bill for surgical removal of two teeth and other bills from blood work. She gets low-cost care at Family Health Centers-Portland, but sometimes skips care because of the cost. “I may just stay at home and just suffer with the pain and everything,” she said.

Thoughts on expansion: “I think it would help a lot of people.”

Link to article:  http://www.courier-journal.com/apps/pbcs.dll/article?AID=2013305090048

Medicaid health insurance to expand under Obamacare in Kentucky

Beshear touts benefits while others question decision’s costs

Written by
Jessie Halladay
The Courier-Journal
Kentucky Gov. Steve Beshear will expand Medicaid: The Medicaid program will be expanded undervthe federal Affordable Care Act

FRANKFORT, KY. — More than 300,000 uninsured Kentuckians will become eligible for Medicaid after Gov. Steve Beshear announced Thursday that the state will expand the health insurance program — taking advantage of President Barack Obama’s controversial Affordable Care Act.

“This is both the single biggest decision affecting the collective health of Kentuckians in our lifetime, and it was also one of the easiest to make,” Beshear said during a news conference at the Capitol.

He cited a study by the Cabinet for Health and Family Services that said expanding Medicaid would benefit hundreds of thousands of Kentucky families, improve the state’s failing health, create nearly 17,000 jobs, and have a $15.6 billion positive economic impact on the state between fiscal 2014 and 2021.

The study also said Kentucky would see an $802.4 million positive impact on the state budget for that period because some expenses would be moved to the federal government. Without expansion, the study says Kentucky would see $38.9 million in additional costs because of changes under the Affordable Care Act, also known as “Obamacare.”

Beshear said the Medicaid expansion, when paired with the Health Benefit Exchange the state is setting up under the health act, will provide an opportunity for every Kentuckian to have access to affordable health insurance.

Under the expansion, parents and low-income adults younger than 65 with incomes up to 138 percent of the federal poverty line — $15,856 for an individual or $32,499 for a family of four — will become eligible for Medicaid.

Medicaid enrollment for those newly eligible would start in October, with coverage beginning Jan. 1.

Bill Wagner, executive director of Family Health Centers in Louisville, said that will “significantly change” people’s lives, including 20,000 patients who visit his clinics.

“The impact of expanded access is simply to … improve the health of Kentuckians and to remove what I think is a significant burden of worry about, ‘How I will pay for my family’s health care in the future?’ ” Wagner said.

Terry Brooks, executive director of Kentucky Youth Advocates, which has lobbied for expansion, said it is a “smart investment for Kentucky” because of the health and economic benefits for children and their parents.

“As health outcomes improve due to more people being insured and receiving needed health services, health care costs are likely to decrease and money will be saved,” Brooks said.

But House Republican Leader Jeff Hoover of Jamestown questioned whether Kentucky can afford the change, saying the “expansion has the potential to have a significant impact on other functions of state government” when the state is “inadequately funding our schools at all levels.”

Under the plan, the federal government will pay 100 percent of the costs of expansion for the first three years, and the state will start paying a portion of the costs in 2017, capped at 10 percent in 2020.

Under the current system, Kentucky pays 30 cents of every dollar spent on Medicaid, while the federal government pays the rest. The state now spends about $1.5 billion annually on Medicaid.

Beshear said the newly covered people should expect benefits equal to those received by current Medicaid recipients.

Audrey Tayse Haynes, secretary of the Cabinet for Health and Family Services, said people being added to the Medicaid system will be covered through managed care companies already operating in Kentucky.

Tracey Hayes, 29, a single mother who works full time at a child-care center that does not provide insurance, said she would be the first in line to enroll under the expansion.

While her two girls have health care through the state’s KCHIP program, she pays out of pocket when she has an ailment serious enough for her to seek medical care. “My bills, they pile up because I can only pay a little at a time,” she said. “It’s very stressful.”

The 2010 Affordable Care Act established parameters that required states to expand Medicaid or lose funding, but a June 2012 Supreme Court decision said the federal government couldn’t use existing Medicaid funds as leverage, which made the expansion optional. Kentucky is among 22 states and the District of Columbia that have said they will expand coverage.

Beshear did not need legislative approval to go forward because Kentucky’s rules for Medicaid eligibility are set in regulation, not in statute, and can be revised by the governor. Legislative committees then review the new or amended regulations and may accept or reject them.

But the governor can implement the regulations regardless of any objections.

Political responses

State Sen. Julie Denton — a Louisville Republican who heads the Senate Health and Welfare Committee and proposed a failed bill to prohibit Beshear from expanding Medicaid without legislative approval — said she is concerned that the long-term costs of expansion will outweigh the benefits, particularly if the federal government changes the terms of the deal and requires a bigger contribution from states.

“There’s no certainty” that the contribution will stay the same given the economy, Denton warned. “This isn’t a small measure. … This is too big of an issue for one person’s discretion.”

U.S. Senate Minority Leader Mitch McConnell of Kentucky issued a statement expressing “surprise” with Beshear’s decision, “given Kentucky’s struggles to finance its current Medicaid program.” The action, McConnell said, could exacerbate “the already serious access-to-care problems we face in Kentucky.”

Tom Underwood, Kentucky state director for the National Federation of Independent Business, said his group is concerned about the cost to the state. “Show us the money, is what we’re asking.”

But U.S. Rep. John Yarmuth, a 3rd District Democrat who supported the Affordable Care Act, called Beshear’s decision “historic.”

“There are thousands of Kentuckians whose lives have already been improved — and some saved — because of the Affordable Care Act,” he said.

House Speaker Greg Stumbo, D-Prestonsburg, said he “would challenge any public official opposing this move to surrender his or her own health care coverage.”

“I think it is hypocritical of those with excellent, taxpayer-supported benefits to criticize others who will now have accessible and affordable health care,” he said.

And Dr. LaQuandra Nesbitt, director of the Louisville Metro Department of Public Health and Wellness, said the expansion “is a great step toward achieving equity in access to health care and that, over time, should help to make our citizens healthier and to lower health costs by getting people to the right place, at the right time, for the right care.”

Statistics released by Beshear’s office show that 101,366 Jefferson County residents lack insurance. Under the Medicaid expansion, 47,451 of those will now qualify for the program.

An additional 44,294 will have access to subsidized insurance through the Health Benefits Exchange.

Most providers and advocates also supported Beshear’s decision.

Thomas Johnson, spokesman for Norton Healthcare, said in a statement: “Given the commonwealth’s poor health status — the nation’s highest mortality rate and rankings among the highest in cancer, cardiovascular disease and obesity — expanded coverage will help eliminate barriers to care.”

Sheila Schuster, an advocate with the Kentucky Mental Health Coalition, said expansion is “absolutely the right thing to do.”

But she said many still want to see concerns and problems with the implementation of Medicaid managed care worked out. In the past year, there have been complaints by some providers about delayed payments and from consumers about changing benefits.

Schuster said she hopes the system can be operational by the Oct. 1 enrollment deadline, as Beshear pledged. “It’s a lot of people to get in the system in a short amount of time.”

Reporter Jessie Halladay can be reached at (502) 582-4081 or on Twitter at CJ_JHalladay. Reporters Laura Ungar and Tom Loftus contributed to this report.

Link to article:  http://www.courier-journal.com/apps/pbcs.dll/article?AID=2013305090046

Quotes: What local leaders are saying about Medicaid expansions

“The financial impact on the expansion will not hit the state for a couple of years if the federal government picks up the cost for the next three years as promised. This governor will be out of office by that time.”

Jeff Hoover, Kentucky House Republican Leader


“I would challenge any public official opposing this move to surrender his or her own … excellent, taxpayer-supported benefits.”

Greg Stumbo, Kentucky House Speaker


” This is a great step toward achieving equity in access to health care and that over time should help to make our citizens healthier and to lower health costs by getting people to the right place, at the right time, for the right care.”

Dr. LaQuandra Nesbitt, director of the Louisville Metro Department of Public Health and Wellness


“I continue to believe this should not be a unilateral decision by the executive branch.”

Robert Stivers, Kentucky Senate President


” It would really help relieve some of the burden families feel that are currently uninsured and worry about having some unexpected medical condition that could lead their family to bankruptcy.”

Bill Wagner, executive director, Family Health Centers


“My (medical) bills, they pile up because I can only pay a little at a time. It’s very stressful. I have a full-time job and it just isn’t enough.”

Tracey Hayes, 29-year-old uninsured single mom and daycare employee


“We believe that health care is a basic human right. … We measure governmental policies by asking this primary question: How will this policy affect poor persons? Today, the governor answered correctly.”

The Rev. Patrick Delahanty, executive director of the Catholic Conference of Kentucky


“Our Kentucky Health Issues Poll shows that a vast majority of Kentuckians — more than 80 percent — favor providing access to affordable, quality health care for all Americans. We applaud the governor’s decision.”

Susan Zepeda, president and chief executive officer of Foundation for a Healthy Kentucky


“The long-term financial impact of this expansion — coupled with other growing pressures on hospitals — remains to be seen.”

Carl Herde, chief financial officer, Baptist Health


“It is the right thing to do for our most vulnerable citizens.”

Ruth Brinkley, chief executive officer, KentuckyOne Health


“Adding more people to the Medicaid rolls will put a squeeze on the program’s core mission, which is children, pregnant women, the disabled and vulnerable seniors.”

Brett Guthrie, U.S. representative, R-Bowling Green

Link to: http://www.courier-journal.com/apps/pbcs.dll/article?AID=2013305090091

Passport Health Plan Offers Text4baby Program – Helps Members Give Babies a Healthy Start in Life

Louisville, KY – Passport Health Plan is pleased to announce it now offers Text4baby – a free texting service to provide health information to pregnant women and new moms from pregnancy through a baby’s first year.

Passport has chosen to take an active role in caring for new babies by being the presenting sponsor for the March of Dimes’ Walk for Babies on May 11, 2013 and will also promote Text4baby on its website and within the Plan’s prenatal Mommy Steps program for pregnant members.

“Every woman deserves access to information that will help her give her baby the best possible chance at a healthy start in life,” said Judy Meehan, CEO, National Healthy Mothers, Healthy Babies Coalition. “It’s partners like Passport that are making it possible for Text4baby to deliver health messages to those who need them most.”

Women who sign up for the service by texting BABY to 511411 (or BEBE for Spanish) receive three free SMS text messages each week timed to their due date or baby’s date of birth. These messages focus on a variety of topics critical to maternal and child health, including birth defects prevention, immunization, nutrition, seasonal flu, mental health, oral health, safe sleep, and more. Text4baby messages also connect women to prenatal and infant care services and other resources.

“Passport Health Plan is dedicated to helping Kentuckians lead healthier lives and ensuring more babies get a healthy start to life,” said Mark B. Carter, CEO of Passport Health Plan. “We’re excited about sponsoring March of Dimes’ Walk for Babies and offering Text4baby to our pregnant members. These two initiatives will help reduce Kentucky’s high percentage of pre-term births which is currently at 13.4% .  The March of Dimes provides vital research to prevent these pre-term births and Text4baby will give these members the health information they need through the convenience of personal text messages.”

According to the National Healthy Mothers, Healthy Babies Coalition, each year in the U.S., more than 500,000 babies are born prematurely and an estimated 28,000 children die before their first birthday. The infant mortality rate in the U.S. is one of the highest in the industrialized world, and for the first time since the 1950s, that rate is on the rise. Research shows over 85% of Americans own a cell phone and 72% of cell users send or receive text messages.

Text4baby is made possible through a broad, public-private partnership that includes government, corporations, academic institutions, professional associations, non-profit organizations, and more.

 About Passport Health Plan

Passport Health Plan is a provider-sponsored, non-profit, community based, Medicaid health care plan that has operated since 1997. The Plan was established by providers upon the invitation from Kentucky’s Department for Medicaid Services to area providers to take responsibility for the medical care of Medicaid patients for its 16 county region.  The Plan has been consistently rated as “excellent” by the National Committee for Quality Assurance.

The counties of service include Breckinridge, Bullitt, Carroll, Grayson, Hardin, Henry, Jefferson, Larue, Marion, Meade, Nelson, Oldham, Shelby, Spencer, Trimble and Washington.   Passport Health Plan is sponsored by the University of Louisville Medical School Practice Association, University Medical Center, Inc., Jewish Heritage Fund for Excellence, Norton Healthcare, and the Louisville Primary Care Association, which includes the Louisville Metro Department of Health and Welfare and Louisville’s two federally qualified health centers, Family Health Centers and Park DuValle.  For additional information, visit www.passporthealthplan.com.

Passport Health serves us well

As a local eye doctor, I see a great number of Passport Health Plan members and have for over a decade.  The federal government recently changed a rule and has allowed other insurance plans to come into Shelby, Henry, Spencer and other counties as alternate providers to Passport.  The state has gone as far as to randomly shuffle the deck and disperse 75 percent of previously covered Passport patients to other insurance plans.  While I have heard that competition is good from one side and how only the government would break an unbroken thing from the other, one thing remains constant:  Passport is a really great plan for its members.

That is why I have urged my patients that currently have Passport to call 855-446-1245 and tell the state Medicaid office that you want to stay with Passport.  If you have friends, clients, patients or family on Passport, I would urge you to do the same.  The opportunity to switch ends on Dec. 15, so it is important to make this call soon.

Some plans will urge you to try their plans, but you don’t have to.  And why would you?  Passport is widely known as one of the country’s best health-care plans in terms of quality, and it has many innovative programs to help members improve their lives and those that they love.  This has all been done while saving the state of Kentucky millions of dollars.

It’s not often you will hear someone from the medical community champion the cause of an insurance company.  However, Passport, in my opinion, has been solidly working for my patients, treats my office fairly and has done so for about 15 years.  I believe in what they do and how they do it.  In fact, I have been a volunteer on the Passport Partnership Council as the vision representative for 14 of those 15 years.

Again, I urge you to call the number above or inform those you know that have Passport to do the same.  Soon.

 

Dr. Dan Bowersox

Shelbyville

Study points to problems in Medicaid managed care

GOVERNMENT KENTUCKY SEAL

Written by
Mike Wynn
The Courier-Journal

FRANKFORT, KY. — A new study funded by the Foundation for a Healthy Kentucky says the state’s Medicaid managed-care program has led to gaps in health care services and appears to lack case management efforts needed to improve care.

Gov. Steve Beshear implemented the managed-care system in November 2011 with the goal of saving millions of dollars and improving health care for roughly 560,000 low-income and disabled beneficiaries outside the Jefferson County region.

The study — presented to the joint Health and Welfare Committee on Friday — evaluated the first eight months of the program, raising questions over the adequacy of provider networks, new administrative requirements and quality care for patients.

Among the key findings, the study reported that:

• Advocates are concerned about gaps in behavioral health care while providers said patients have experienced breaks in medication for chronic conditions.

• Provider networks continue to fluctuate, and case studies indicate that many providers do not contract with all the managed-care companies in the program.

• Providers and advocates said they have not seen “substantial evidence” of new case management programs.

• Auto-assignment of beneficiaries into health plans caused patients to switch plans at a high rate during the start-up phase.

• Managed-care companies are dissatisfied with capitation rates and question the ability to provide quality services at those rates.

• Health care providers report problems working with the managed-care companies, including delays in prior authorizations for services, claim denials and difficulties getting information and understanding company coding systems.

Friday’s study represents the initial findings of a three-year evaluation that the foundation is funding to review implementation of managed-care in Kentucky. But advocates, health-care providers and lawmakers have been decrying most of the issues for months.

Senate Health and Welfare Chairwoman Julie Denton, R-Louisville, said the report didn’t shed much light on the issues but helped reiterate some important points.

“I was right over a year ago when I said this is going to be a disaster,” she said.

Sen. David Givens, R-Greensburg, called the report a “little soft” in its discussion of the issues, but said the Beshear administration should weigh those concerns when considering the benefits and costs of expanding Medicaid.

The state originally contracted with three managed-care companies — CoventryCares of Kentucky, Kentucky Spirit Health Plan and WellCare of Kentucky — under a three-year deal to administer the $6 billion federal and state program.

The Jefferson County region, which comprises around 170,000 patients, was managed under an exclusive contract with Passport Health Plan for the past 15 years. But the federal government required Kentucky to establish more competition in the region this year.

In response, the state has contracted with four companies — Passport, Wellcare, Coventry Cares and Humana — to serve the region, and Passport has since filed a protest against the state’s bidding process.

Denton, in a charged criticism of the health cabinet Friday, said the move will drive up operation costs and bring problems from across the state into the Jefferson County region.

Cabinet Deputy Secretary Eric Friedlander countered that many states have faced the same issues “but that is no reason not to move forward and try to make the system better, which is what we will try to do and have been trying to do.”

http://www.courier-journal.com/article/20121109/NEWS01/311090088/Study-points-problems-Medicaid-managed-care

 

Kentucky violated bidding process in awarding Medicaid contracts, Passport says

Written by Tom Loftus The Courier-Journal
Oct. 31 courier-journal.com

FRANKFORT, KY. — The state violated its own bidding process and will spend as much as $80 million more than necessary per year under its new Medicaid managed care contracts for the Jefferson County region, Passport Health Plan charged Thursday.
In another bump for the state’s transition to Medicaid managed care, Passport Health Plan filed a formal protest of the process that resulted last month in the awarding of state contracts to four companies in the Jefferson County region now served exclusively by Passport.

Passport’s complaint is over the way the state Cabinet for Health and Family Services’ divided the region’s 170,000 Medicaid recipients among the four companies.
The protest letter says that Passport officials learned Wednesday that Passport will initially be assigned only 27 percent of the region’s Medicaid recipients while the contracting process and a cabinet official previously indicated it would get 41 percent. “I am convinced that patients will be harmed if the arbitrary assignment process is utilized,” Passport CEO Mark Carter said in a news release.

The protest asks that for a halt of the assignment process and for the cabinet to “make different decisions that will protect both the state budget and the Medicaid recipients.”
The cabinet released a statement late Thursday that said, “Passport is protesting issues that all bidders were advised of during negotiations. Passport was well aware of the assignment plan before it signed a contract.”

Passport, a nonprofit formed by local health care providers, has held an exclusive contract to manage the state’s Medicaid program in the Jefferson County region for 15 years.
In an effort to save money in the Medicaid program, the Beshear administration last year awarded contracts to managed care companies to serve the remaining 104 counties in the state. This year the federal government directed Kentucky to establish more than one managed care provider in the Jefferson County region.

That resulted in a long bid-negotiation process ending in the cabinet’s announcement a month ago that starting on Jan. 1, four companies will serve the region: Passport, Wellcare, Coventry Cares and Humana.

In its letter of protest, Passport said that discussions before and after contracts were awarded indicated that a formula for assigning members to one of the four companies would result in Passport getting 41 percent of the region’s Medicaid population.

The letter said that as recently as last week Passport was told by Medicaid Commissioner Lawrence Kissner that he believed Passport would get 41 percent. That’s because the formula is partly based on the company’s network of doctors, hospitals and other providers. Passport has had a comprehensive roster of health-care providers under contract in the region for more than a decade.

But on Wednesday Passport was told that under the formula, it will initially be assigned only 27 percent.

“To Passport’s knowledge, nothing has been done by the Commonwealth to assess whether the other (companies) are ready” in the region, the letter says. “Passport, based on its long history as a Medicaid contractor in the region, is clearly ready.”
Passport also charged that the cabinet’s approach will be much more expensive than necessary.

The bidding process, the letter says, resulted in the cabinet awarding contracts that will pay the four companies the following average amount per Medicaid member they serve per month: $446 for Wellcare, $457 for Passport, and $473 for both Coventry and Humana.

But in the protest letter, Carter said Passport had told the state at the beginning of the bidding process it was willing and able to bid much lower — $423 per member per month — if it could be assured it would be assigned about 80 percent of the region’s recipients.
The state will end up spending “about $80 million more than it would have been required to spend,” had it agreed with that offer, Carter said in the letter.
Reporter Tom Loftus can be reached at (502) 875-5136.

Medicaid Operators Look to Take Place of KY Spirit

By Kenny Colston, KPR-Frankfort

WEKU.fm Mon October 22, 2012

 

As the fallout continues from the announced departure of statewide Medicaid operator Kentucky Spirit, many other Medicaid operators are already looking to take their place. Kentucky Spirit announced last week they would break their contract with the state early. State officials say they won’t re-open those statewide contracts to replace Kentucky Spirit until the current contracts expire.

When the state first decided to implement Medicaid managed care statewide, seven companies initially expressed interest. But only three received contracts: Kentucky Spirit, Coventry Cares and WellCare.

Bidding for statewide contracts won’t occur again until late next year. But Cabinet for Health and Family Services Secretary  Audrey Haynes says all four Louisville region operators have expressed interested in getting statewide contracts.

“All of those companies are interested in looking statewide with us in the future, they’ve all voiced that,” Haynes told lawmakers at a recent committee hearing.

That would include statewide contract renewals for Coventry Cares and WellCare, but new statewide contracts for Humana and Passport. All four currently are slated to serve the Louisville region.

Passport CEO Mark Carter says his group is interested in expansion and has received encouragement to do so.

“In fact while some of the implementation challenges have taken place in the rest of the state, we received a number of unsolicited calls asking us if we would try to work with the Cabinet to expand currently,” he says.

Carter says Passport’s reputation for quality care is well-known throughout the state and is a positive for his company. He says the reasons Passport wants to expand is to help maintain staffing levels since they no longer have exclusive rights to the Louisville region and to expand their quality of care to those currently outside its service region.

Humana officials have not responded to a request for comment on what their plans are.

Link: http://www.weku.fm/post/medicaid-operators-look-take-place-ky-spirit