Auditor Edelen says Medicaid providers 8 percent fewer under managed care; cabinet says report is limited, outdated

The number of people relaying on Medicaid will increase
dramatically in 2014, as Kentucky expands it to include people with incomes up to 138 percent of the federal poverty level, but there is more concern than ever about the availability of health-care providers to treat them.

A review
released Wednesday said the number of Medicaid providers in Kentucky declined 8 percent in the first six months of a managed-care system that has been unpopular with providers. Roger Alford of The Associated Press reports that some hospitals in border states have already stopped accepting Kentucky Medicaid, which went to managed care in November 2011.

After the Patient Protection and Affordable Care Act
goes into effect Jan. 1, an additional 300,000 Kentuckians may be
added to a program that already serves nearly 800,000.
State Auditor Adam Edelen raised concerns whether Kentucky’s rural
hospitals could continue to deal with Medicaid’s slow reimbursements
under managed care. He said, “Managed care is designed to
save taxpayer dollars, but it can’t be at the expense of the health of
our citizens.”

A clinic on Main Street in Frankfort recently joined Medicaid.

State Cabinet for Health and Family Services spokeswoman Jill
Midkiff told Alford the auditor’s
review was “limited and somewhat outdated” and said it “doesn’t fully and
accurately reflect” the status of the managed-care system.

Edelen told Kentucky Health News that the audit ran only through May 2012 because his office typically deals with fiscal years. State fiscal years end June 30. He said he believes the trends have continued.

Midkiff said “The
overall number of Medicaid providers has actually grown under the
managed care program,” Alford reports. “She cited a 20 percent increase in dentists, a 150
percent increase in certified nurse practitioners, and a 300 percent
increase in physician assistants.” She said, “The cabinet firmly supports managed care as the best way to deliver
needed medical services to a vulnerable population while also providing
good value to Kentucky’s taxpayers.”

She also said, “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 and that Medicaid members are receiving prompt, effective medical services with measurable improvements in health outcomes.” (Read more)

“Midkiff said Tuesday other issues cited in Edelen’s report are not the result of managed care because they existed before its implementation, including the adequacy of medical providers in Kentucky, and it does not belie the need to expand Medicaid services, Ronnie Ellis of CNHI News reports.

Edelen made several recommendations, including:
• Establishing a formal advisory panel of members and stakeholders
• Requirements for retaining claims records
• Establishment of an approval process for subcontracts with MCOs,
including third party providers for dental, vision and behavioral health
services
• Improved monitoring of MCO accounts payable
• Establishing a way to estimate the cost savings of managed care for
the state.

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