The problems with privatized Medicaid in Eastern and Western Kentucky could be coming to Louisville.
Passport Health Plan has run Medicaid in Louisville and the surrounding area for more than a decade. The system was the model for last year's Medicaid privatization, which brought three new Medicaid management companies into the state.
The federal government has ordered the state to open the Passport region to competition by next year. But Medicaid privatization isn't working too well in the rest of the state. Hospital officials claim two of the private companies aren't paying enough to reimburse Medicaid-covered care. The private operators say they are only adhering to their contracts with the state.
“Let’s make sure we have a plan,” says Senate Health and Welfare Committee Chairwoman Julie Denton. “If we are going to be bidding out with the Passport region for next year, starting January 1st, the Cabinet sure as heck better be working on an RFP and putting it together in a more thoughtful and steady fashion than they did the Medicaid managed care RFP for last year.”
The state has until July 1 to tell the federal government its plan to open Louisville to competition. But the Cabinet for Health and Family Services hasn't yet begun work on the plan.
The current three statewide operators all have offices in Louisville, making them obviously competition partners for the region. But Denton says she’s not sure bringing those three in is a good idea.
“I don’t think they can just take three bids from the three MCOs and open those up and let those three MCOs in. And frankly with the way Coventry has been working thus far, I have no interest in letting them into the Passport region,” she says.
Currently, many healthcare systems are having contract issues with CoventryCares, one of the three new statewide MCOs. Coventry officials say they need more operating money and the company is looking to providers and patients to recoup profits. That has led to lawsuits and threats from lawmakers that Coventry could be barred from operating in the commonwealth.