Medicaid Providers Complain of Managed Care Mismanagement

Kentucky’s private Medicaid providers say they need immediate changes in the state Medicaid system. Kentucky turned the system over to managed care providers four months ago. And today doctors, pharmacists and hospital executives told a Senate committee how disastrous the change has been.Kentucky currently contracts with four Managed Care Organizations, known as MCOs. Passport is based in Louisville, while Kentucky Spirit, WellCare and Coventry Cares operate statewide.The providers say the three statewide MCOs are mismanaged and ineffective. They say their claims aren’t reimbursed on time, and the MCOs aren’t consistent about pre-authorizing treatments and medication.Shawn Jones is a doctor in Paducah and the president of the Kentucky Medical Association. He says the pre-authorization system needs to be overhauled.“This bureaucratic nightmare needs to change," Jones said. "First the MCOs need to pare down the number of procedures and treatments that require pre-authorization. Second, they need more uniform and timely processes to review the pre-authorization requests, and thirdly some sort of appeals process should be established.”Jones said in one case, he wasn’t able to get pre-authorization for a child’s birth until after the child was born.Previously, independent pharmacists told the legislature's program review committee that their businesses were being killed off by slow repayments.  Today, the pharmacists continued to say that MCOs are underpaying, paying late or refusing to allow medicine to be given out.Riverdell Behavior Center CEO Janice Richardson says if that process isn’t reformed, serious incidents will occur.“We’re not able to give them the medicines that have been proven to help them," Richardson says. "And based on that it is a consensus from at least the psychiatric and behavioral facilities that somebody’s gonna get hurt. And it’s gonna be bad when it happens.”Some providers said that four months in, such serious problems shouldn't be occurring. The problems aren't central to one MCO either. The providers said CoventryCares is the easiest to work with on dental issues, but the worst with hospitals. Many also complained about Kentucky Spirit.The only organization not criticized was Passport, which has operated in the Louisville area for more than a decade.The Cabinet for Health and Family Services, which oversees the managed care program, says it's continuing to help providers and MCOs with issues. The MCOs are expected to testify in committee next week.