Medicaid Regulations No Match for Rural Roads

 

The dispute between an Eastern Kentucky hospital chain and private Medicaid operators has lawyers arguing distance versus drive time. Under state regulations, a private Medicaid operator cannot sign up a patient unless it has a doctor or hospital within 60 miles of that patient’s home. But that distance is measured as the crow flies and the state doesn’t take into account narrow and winding Appalachian roads. For many patients, it may be faster to visit a doctor that’s 70 miles away than it is to visit one that’s 50 miles away.That’s prompted the Appalachian Regional Healthcare hospital chain to argue against the 60-mile rule.

ARH says it has hospitals that are easier to get to for Eastern Kentucky patients, therefore no private operator could have a proper healthcare network without a contract with ARH. The state and private operators disagree.

“I think they do realize there is an issue there it’s just a question of how’s that’s been interpreted,” says Anne Hadreas with the Kentucky Equal Justice Center.

State regulations also say providers within a one-hour drive are in a patient’s network, but Hardreas says that isn’t often enforced.

“It definitely puts more of a burden on the consumer and we’re talking about Medicaid patients here who are by definition are low income and it means that they will have to travel farther to get the same amount of care,” she says.

Medicaid Fraud Bill Introduced

Medicaid Fraud Doesn’t Pay, Yet

A bill that would allow Kentucky to collect money from Medicaid fraud busts has again been introduced in Frankfort. House Speaker Greg Stumbo filed the bill, which would also protect and possibly reward whistle blowers who report fraud in Medicaid or any other areas of state government. Stumbo says the bill is needed to help Kentucky get money that usually ends up in federal coffers.

“It’s a choice of revenues, state or federal, the states that don’t have a state law don’t have the option to get any of that forfeiture money or penalty money,” Stumbo says.

The bill passed the House last year. The Senate passed a similar bill that only dealt with Medicaid fraud, but the two sides couldn’t come together for a compromise.

Stumbo says he thinks some form of legislation that deals with fraud revenues will pass both chambers this year.