Health advocate says managed care has not improved and is hurting vulnerable Kentuckians

03/06/2013 01:48 PM

Kentucky’s transition to Medicaid managed care is endangering the care of some of Kentucky’s most vulnerable citizens who rely on Medicaid to cover their medical care, said Dr. Sheila Schuster of the Advocacy Action Network.

Leaders of the state’s Health and Family Services cabinet officials say the system is improving after its rocky start 15 months ago. But Schuster, a licensed psychologist and is Kentucky’s best known lobbyist for Kentucky’s vulnerable citizens, said last week on Pure Politics that she disagrees.

She said ongoing billing problems between the managed care companies and the hospitals and doctors is making it more difficult for many of them to continue accepting Medicaid patients.

“Early on the problems were about access to medication and sufficient stays in hospitals to get people stabilized. Now the added problem is providers aren’t getting paid,” Schuster said (at 5:30 in the interview below).

The House has passed a bill to set up a panel to mediate these billing disputes. In the meantime, it is affecting Medicaid patients who are some of the most vulnerable Kentuckians often requiring the most help, both with illnesses and mental health needs.

State Medicaid Commissioner Lawrence Kissner has said that the job of Medicaid is to enforce the contracts, and providers or customers would talk directly with the managed care organizations. But Schuster said patients she talks to haven’t had that experience.

“You can imagine how difficult and frustrating it is for someone with a serious mental illness or other disability to try to go through the telephone maze to get through to a real live person at an MCO only to be told you’re calling the wrong person or ‘I don’t know what you’re talking about’,” Schuster said (at 3:45).

And when it comes to whether or not to continue the managed care set-up, Schuster said she would like to see it end but there are some big issues making it difficult to terminate.

“The money has been spent, the contracts have been signed, the $1.3 billion that was contracted has been given out in per member per month. I don’t know what you do if you break those contracts. It will be lawsuits and all these other things” (at 9:05).


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