Category: Medicaid

I have been out of the country these last two weeks and am trying to catch up. Perhaps the biggest news item while I was away happened just as I left town – the election of Matt Bevin as our next Governor.  I had only just learned of this fact when I was contacted by an out-of-state reporter who asked whether people in Kentucky who gained coverage through Medicaid expansion or through our KYNECT state insurance exchange should be concerned.  If so, why would people who only so recently obtained healthcare coverage vote for Mr. Bevin – as they obviously must have in winning fashion?

Of course they should be concerned!
I responded that based on Mr. Bevin’s campaign promises and comments alone, as reported by our local press, current KYNECT and Medicaid expansion recipients have every reason to worry about their future coverage and access to healthcare.  I would certainly worry if I were in their shoes and not the satisfied Medicare beneficiary that I am.  In the heat of the campaign, and to appeal to virulent anti-Obama haters, Tea-Partiers, and other conservative voters; Mr. Bevin unequivocally promised to undo as much as possible of the Affordable Care Act (ACA) implemented in Kentucky by Governor Steve Beshear.  At least that is what I heard.

Real promises or campaign maybes?
Campaign promises included unwinding Kentucky’s successful KYNECT insurance plan, or switching it from a state-run plan to a federal plan.  It also seemed clear to me that Mr. Bevin promised to end or roll back the Medicaid expansions that have numerically provided the most coverage to previously uninsured Kentuckians. (Mr. Bevin later apparently hedged his promise to something short of a full roll-back.)  Much was made during the campaign of Mr. Bevin’s possible confusion of Medicare and Medicaid, and statements about whether beneficiaries of publicly-financed healthcare should be required to submit urine tests for illegal drugs.  I took some of this to be red-meat stuff thrown Trump-style by both parties to their admiring crowds.  I would rather see Governor-elect Bevin improve what we have rather than walk away from it solely to satisfy his political base. Continue reading “Big-Change or No-Change in Post-Election Kentucky Healthcare?”

Who is getting paid for what? Why should we care?

Some months ago I reported on the shifting enrollments of Medicaid Managed Care beneficiaries among the four Managed Care Organizations (MCOs) in Region 3, which includes Louisville and a few surrounding counties. Although the initial assignments by the state gave roughly equal numbers of beneficiaries to each of the MCOs selected to do business in the Region, Passport was able to leverage its previous home-court, sole-source advantage; and cooperation from its existing participating providers to recapture the lion’s share of patients from its new competitors. In this installment, I show the final enrollment figures as of April 2013 when the relatively unfettered ability of a member to change from one plan to another expired. The big winner continues to be Passport which expanded its Region 3 market share to 75% compared to 64% early last February.

Medicaid Managed Care was reintroduced elsewhere in the state in January 2012. In little more than a year, the distribution of enrollees outside Region 3 shifted to favor two of the three MCOs. (It didn’t help that one of the MCOs has already expressed interest in leaving the state.) Competition, as opposed to cooperation, produces winners and losers. The hope (and it remains a hope) is that patients will come out winners. I present some enrollment figures below as well as the rates paid by the state to the MCOs to cover the care of beneficiaries. A table of the data can be downloaded here.

Continue reading “Passport Takes Further Commanding Lead in Region 3 Medicaid Managed Care.”

Region 3 of Kentucky’s Medicaid system, comprising Jefferson and nearby counties, is in the throes of a major reorganization. Beginning January 1, the previous monopoly to provide Medicaid services held by a consortium of providers organized by the University of Louisville was withdrawn. State contracts were offered to three additional Medicaid Managed Care Organizations (MCOs). The timing of this major change was not the most felicitous, given that the statewide Medicaid managed care system newly put in place January 2012, could be said sympathetically to be in chaos. Medicaid managed care has been operational in Region 3 for several years and was providing acceptable clinical services, albeit under a cloud of abusive if not illegal management by its UofL-controlled financial administration. (One might say it was used as a slush fund. No one went to jail, but people lost their jobs and a major reorganization was demanded by the state.)

Given that the new contracts and procedures in Region 3 are essentially the same as those now used statewide, it is instructive to see how things have been going in the rest of the state. Alas, the precedents are not rosy. “Medicaid-Meltdown” is a term that is frequently being used. The rocky start may be one of the reasons the state is withholding its approval of expanding the Medicaid program under the new federal Accountability and Affordability Act to provide more Kentucky individuals health insurance coverage. In that regard, an interim report funded by the Foundation for a Healthy Kentucky and prepared by the Urban Institute and the University of Kentucky is receiving much attention nationally and is relevant to Region 3’s future. (Click the “Medicaid” category link in the left column of the Blog home page for available earlier comments.) Continue reading “Passport Medicaid Health Plan Winning Majority of Medicaid Beneficiaries.”