Medicaid leader says he's confident managed care will provide proper care, save Ky. money

04/17/2011 05:57 PM

Paying private health care providers to manage the medical needs of Kentucky’s poor and disabled will hold the costs of Medicaid to $6 billion next year — essentially the same it is now, the acting Medicaid commissioner said.

An estimated 550,000 people out of the 822,000 who currently rely on Medicaid will be under the umbrella of a managed care system, said Neville Wise, who has been acting Medicaid commissioner since last fall.

The managed care program would also help achieve efficiencies in future years, he said on the Thursday edition of Pure Politics.

Without contracting with those private and non-profit health care providers, the cost of the Medicaid program will be $6.4 billion next year.

On April 7, the state issued requests for proposals from health care companies to bid on how they would cover the poor and disabled who rely on Medicaid and how much they’d charge the state to manage that care.

The Medicaid Department is on the hook to come up with about $500 million in savings in the next fiscal year. The legislature passed a fix to Medicaid budget based on moving money from fiscal year 2012 to plug a hole in this year’s budget — and Gov. Steve Beshear promised his administration could come up with savings next year to balance it out.

Under the new plan, only those that are in long-term care such as nursing homes, those who are mentally disabled or those in community care programs, would be directly paid by the state Medicaid program.

Wise took the helm of Medicaid when the program had reached a $500 million shortfall and the previous commissioner Elizabeth Johnson resigned to take a job at Stites and Harbison, the law firm for which Beshear worked.

Senate President David Williams, R-Burkesville, has been critical of the Medicaid program because it lacked oversight of the most established managed care program, Passport, which covers Medicaid services for Jefferson County and 15 surrounding counties.

Williams said a state audit that revealed improper spending and excessive payments on lobbying by Passport’s leaders meant that the Medicaid Department didn’t have the capacity to properly oversee outside contractors.

Wise said the Cabinet is working on improvements, with some new staffing and some staff that will move around.

“We have established a new branch within Medicaid which we are currently in the process of staff, which that will be their sole role. To oversee the managed care entities and how they’re complying within the terms of their contract,” Wise said.

Wise said the role of the Medicaid Department will change to more of a monitoring role, monitoring the care and services of the managed care companies the state contracts with.

“We’ll just change our focus and we can do that. We’ve done it before,” Wise said.
Managed care will expand care to psychiatric patients when Kentucky begins its managed care program.

“Psychiatric care, psychiatric issues, you might see services from community mental health centers, psychiatric health centers. Those types of services will be added under our new initiative,” Wise said.

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