US says Jefferson County region must offer Medicaid patients choices
By Courier Journal, Tom Loftus, Published: 2:58 AM, Oct 5, 2012
FRANKFORT, KY. — Beginning Jan. 1, four companies will start managing the health care of roughly 175,000 Medicaid patients in the Jefferson County region — a major change that some say raises concerns about disrupting care.
For the past 15 years, the nonprofit Passport Health Plan has served all Medicaid recipients in the 16-county region.
But on Thursday, the state Cabinet for Health and Family Services said it had signed 18-month contracts with Passport and three other companies — Humana, Wellcare of Kentucky and Coventry Cares — to manage Medicaid recipients’ care starting next year.
Other details of the contracts, including payment provisions, were not released.
Cabinet Secretary Audrey Tayse Haynes said the federal government told Kentucky it could no longer operate with a single managed-care company in the Jefferson County region and must give patients a choice among several providers.
In addition to Jefferson, the region’s other counties are Breckinridge, Bullitt, Carroll, Grayson, Hardin, Henry, LaRue, Marion, Meade, Nelson, Oldham, Shelby, Spencer, Trimble and Washington.
“Passport has been a good partner,” Haynes said. “… But the federal government now requires that individuals have a choice of providers.”
Passport, an organization of major health care providers in the region, was disappointed in the cabinet’s action, and its chief executive, Mark Carter, released a statement expressing concern that the continuity of patient care could be interrupted.
“We will be working with providers and community advocates to minimize disruption in the care of our members,” he said.
Passport had hoped that, if the state went with multiple companies, it initially would assign all recipients to it and then give them an option of moving to another company. Instead, the cabinet initially will assign recipients to one of the four companies.
The cabinet said the state will use “a high-tech matching system” that assigns a person based on “available provider networks and any special health care needs.”
Medicaid recipients will be notified which company they have been assigned to by early November, the cabinet said. They will then have 30 days to change if they wish.
Carter acknowledged that, because Passport’s current business will be shared with three other companies, cutbacks and layoffs are possible.
But he said Passport will begin an advertising campaign soon that will ask recipients to stay with the company. “And if we retain a significant percentage of the population, it may not be necessary to have layoffs.”
A federal decision
Medicaid is the federal- and state-funded health insurance program for the poor and disabled. The federal government pays about three-fourths of the cost, while the state pays the rest.
Passport is the product of an attempt during the early 1990s to save money in Medicaid through managed care. But attempts to form similar organizations in other parts of the state failed.
Last year, under great pressure to curb soaring Medicaid costs, the Beshear administration expanded managed care statewide. Direct management of the program by the state Department of Medicaid Services was handed over to three managed-care companies in Kentucky’s remaining 104 counties.
The transition to managed care in the rest of the state has been bumpy — primarily because of disputes between managed care companies and hospitals within their network of providers.
One dispute raises questions about the network of hospitals and providers that one of the new managed care companies in the Jefferson County region — Coventry Cares — may be able to assemble.
Coventry is already serving the other 104 counties, and KentuckyOne Health said in August that it would terminate its contracts with Coventry.
KentuckyOne Health is the company that resulted from the merger of Jewish Hospital & St. Mary’s HealthCare with St. Joseph Health System early this year.
KentuckyOne said it terminated its contracts with Coventry because Coventry first terminated “without cause” the contracts it had with Our Lady of Peace, a psychiatric hospital that’s part of KentuckyOne, and Taylor Regional Hospital in Campbellsville, which KentuckyOne manages.
Barbara Makovic, spokeswoman for KentuckyOne, said Thursday there’s been no change in the status of KentuckyOne’s decision to terminate its contracts with Coventry. She said she did not immediately know whether KentuckyOne would be part of Coventry’s network of providers in the Jefferson County region.
Coventry released a statement saying it is talking with Kentucky One “and we would be pleased to have them in our network if we can reach an agreement on a new contract.”
Passport Board Chairman Bill Wagner, who is executive director of Family Health Centers in Louisville, said he is concerned that “the chaos that has engulfed the rest of the state over the past year” will come to the Jefferson region.
“Confusion over plan enrollment, increased denials, payment delays and new layers of bureaucracy will definitely have an effect on access to patient care,” Wagner said.
Various health care advocates also expressed concerns about the move to multiple managed care companies.
“The transition is likely to cause disruption for a lot of members who have been served for many years by Passport,” said Jodi Mitchell, executive director of Kentucky Voices for health. “Problems have been documented elsewhere in the state about timely payment of claims to providers, pre-authorization of services causing hurdles to treatment, adequate provider networks and drug treatments might change depending on what plan you’re on.”
Andrea Bennett, deputy director of Kentucky Youth Advocates, said the past year’s experience with managed care out in the state has produced “story after story of parents having difficulty navigating the system. We’ve heard providers threaten to give up on Medicaid altogether because they are frightened and still not receiving proper payment.”
Bennett said that, when the state went to managed care last fall, “sometimes siblings were assigned to separate plans and parents didn’t understand how to switch their child to another plan.”
She strongly encouraged the cabinet to clearly communicate the options to Medicaid recipients in the Jefferson region “in a format that is easy for them to understand.”
Reporter Tom Loftus can be reached at (502) 875-5136.