Daily Independent (Ashland, KY)

Opinion

August 7, 2013

Receiving care

Medicaid providers declining as number of recipients rises

ELIZABETHTOWN — How ironic it would be if the Affordable Health Care Act — aka Obamacare — actually make it more difficult for low-income Kentucky residents to receive health care even though an estimated 300,000 more state residents are expected to qualify for Medicaid under the controversial law.

Why? The demand for medical services could easily outnumber the number of physicians and other health care providers available to meet that demand, particularly in rural counties that already have a shortage of health care professionals.

According to a new report by the office of Kentucky Auditor Adam Edelen, the number of Medicaid providers in Kentucky has dropped by 8 percent since the introduction of a managed care system of delivering medical services to Kentucky’s poor and disabled.

Edelen’s examination called into question the system’s preparedness to bring in an additional 300,000 clients as the state expands its Medicaid rolls as part of the federal Affordable Care Act. In contrast to some other states that have refused to expand Medicaid despite the promise the federal government will pick up the tab for at least three years and 90 percent thereafter, Gov. Steve Beshear issued an executive order for Kentucky to joined the expanded program.

In an effort to stop the red ink gushing for the state’s Medicaid program, Beshear and the Cabinet for Health and Human Services launched a managed care system that pays independent Managed Care Organizations an annual, per-member fee to contract with front-line medical providers to offer treatment to Medicaid clients.

Under the previous fee-for-service system, the providers — hospitals, doctors and pharmacies — directly billed the state for each service. Now they bill MCOs while those organizations have a contracted amount they receive from the state. Managed care is designed both to lower costs and to provide more preventive care and improve health outcomes.

But the managed care system has drawn many complaints from health care providers who say MCOs are consistently late in making payments for services or in some cases have  disallowed medically necessary services.

After legislators heard from providers and clients in their communities, House Speaker Greg Stumbo introduced a bill to set up a mediation process for such claims, but after the General Assembly passed the bill, Beshear vetoed it but acknowledged problems and set up a systemwide review.

Subsequently, Beshear and Medicaid Commissioner Larry Kissner have maintained the problems and a backlog of delayed claims have been methodically reviewed and most of the problems either brought under control or soon would be.

Let us hope so, but when 300,000 new Kentuckians are added to the Medicaid rolls in 2014, the problems are likely to get much worse and the complaints louder and more frequent. 

Edelen said while he believes managed care is the right way to deal with rising costs and the large number of uninsured people in Kentucky, “it has to be a fair deal for providers, members and taxpayers.” His report expresses concern about whether rural hospitals can continue to wait on delayed reimbursements from the MCOs and the subsequent cash flow problems those delays cause.

Spokeswoman Jill Midkiff said the cabinet welcomes the examination by Edelen’s office but said it doesn’t accurately reflect improvements which have occurred since Beshear set up the review.

“The move to managed care was not simple or painless, but our records show evidence of health care providers and managed care organizations working together to adapt to the new Medicaid system,” she said. “Medicaid members are receiving prompt, effective medical services with measurable improvements in health outcomes.”

Earlier this year, Kim McClanahan, CEO of Pathways, the mental health agency that operates in 10 area counties, complained that Medicaid payments under managed care are “seldom” or “never.” We certainly hope the problems have improved dramatically since then and have been all but eliminated before the rush of new Medicaid recipients with the arrival of 2014.

How sad it would be if the existing shortage of health care providers in the mountains gets even worse simply because providers closed up shop because they were unable to meet payroll  and other expenses because of the slowness in receiving Medicaid payments. 

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