Health Cabinet says Ky. Spirit leaving will 'jeopardize the health' of Kentuckians, then says no it won't
06/27/2013 08:44 PM
The state has sounded the alarm by asking the Kentucky Court of Appeals to keep Medicaid managed care company Kentucky Spirit from bolting for another two months or else it will “jeopardize the health” of 125,000 people.
Kentucky Spirit is seeking to break its contract with the state a year before it expires in July 2014. The firm says it’s losing too much money on the deal to manage care for 125,000 poor and disabled Kentuckians who rely on Medicaid to cover their medical care. The firm, a subsidiary of St. Louis-based Centene Corp., announced it plans to pull out July 5.
In two 12-page emergency motions filed Thursday, attorneys for the state and the Health and Family Services Cabinet said even if Kentucky Spirit breaks its contract the firm must stay at least through August to give the cabinet enough time to switch those 125,000 to the other two managed care firms. The attorney’s argued not doing so would cause “irreparable harm … to vulnerable citizens.”
“A sudden cessation of services by Kentucky Spirit would jeopardize the health of its approximately 125,000 members, particularly those who require uninterrupted treatment or care which their new MCO would be unable to coordinate without advance notice,” the motion said.
A footnote goes on to say that the “easiest scenario to imagine” would be for a former Kentucky Spirit patient to go to her doctor only to find out that the physician wasn’t an approved provider for the new managed care firm she had been transferred to — either Coventry Cares or WellCare.
“These conflicts take time to get recognized, be addressed between Kentucky Spirit and the receiving MCO, and get resolved,” the motion’s footnote said. “That is what makes a transition period so vital, particularly for the more medically fragile population …”
But in a telephone interview with Pure Politics on Thursday, Health and Family Services Cabinet spokeswoman Jill Midkiff said Medicaid enrollees assigned to Kentucky Spirit have no reason to fret even if Kentucky Spirit leaves on July 5 as the firm has threatened to do. The cabinet will issue each of the 125,000 people a letter explaining the situation so that their Medicaid coverage would be honored by providers.
“They would be able to go into their physician’s office and say, ‘I had Kentucky Spirit, the state sent me a letter, I’m covered.’ They may not know who they’re assigned to at that point, but their physician’s office would know they are Medicaid members,” Midkiff said. “We’d have to sort through which MCO they’d be assigned to.”
She said the cabinet can’t get a head start on reassigning Kentucky Spirit patients because “we can’t transfer people to another MCO until or unless Kentucky Spirit breaches its contract and leaves early.”
So which is it? Are 125,000 people in jeopardy as the court filing asserts or not?
“The language in the affidavit is persuasive,” Midkiff said. “We don’t want to panic people, but we want to include details about the potential ramifications of individuals falling through the cracks. This is our concern.”
She said that’s what the motion was meant to demonstrate to the Court of Appeals Court.
At stake is also money to the taxpayers.
Franklin Circuit Court Judge Thomas Wingate already ruled this spring that Kentucky Spirit couldn’t break its contract a year early, which means the state can seek damages from Kentucky Spirit.
Midkiff said the amount of damages are up to the courts.
Earlier this week, though, Wingate also denied the state’s request to keep the firm in the state through August, as Tom Loftus of the Courier-Journal reported.
That’s why the issue has landed before the Court of Appeals. Attorneys for Kentucky Spirit have not yet filed a response to the cabinet’s motion as of Thursday night.
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