Medicaid Managed Care system has serious structural issues that will not "get organically better", Edelen says

03/22/2013 12:24 PM

State Auditor Adam Edelen said the state and managed care companies have had enough time to work out glitches with doctors and hospitals and must make some substantial changes before medical care for Kentucky’s neediest suffers any more.

“You have good people in the cabinet trying to manage it, you’ve got provides that are just trying to provide services to people but we’ve got to have a better system of oversight and accountability because if that happen and we begin to lose hospitals in rural Kentucky then we have significantly reduced the level of quality of life for the people of Kentucky,” Edelen said (at 5:00).

Watch the full interview about Kentucky’s managed care troubles:

Hiring private companies to managed Medicaid has helped the state keep its costs down in the $6 billion dollar government program that serves essentially as the insurance company for the poor and disabled. But hospitals, doctors, dentists and other providers say they’re doing that by not paying them for treating medicaid patients.

Edelen says fixing the system for those hospitals and doctors is what is so important to the state as a whole.

“Shoring up the base for rural hospitals, the financial position in Kentucky, I think is the number one challenge to our Medicaid managed care system right now,” (at 1:35).

And while Edelen said he believes Gov. Steve Beshear’s administration is committed to making the managed care system work, the efforts being made just aren’t happening fast enough.

“I think we are now to the place where everybody is so desperate to have this system work that now is the time to strike,” (at 7:45).


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