Managed Care Operators Struggle Early, Kentucky Spirit Loses Members

 

A federal judge has ordered Eastern Kentucky’s largest healthcare provider and one of its major Medicaid operators to talk through their issues before appearing in court this week.

Appalachian Regional Healthcare (ARH) filed suit last month against CoventryCares, which is one of four private Medicaid managed care operators (MCO) in Kentucky. Last year, the state privatized Medicaid adding three new MCOs, but the change has been criticized as happening too quickly, and some issues stemming from the privatization still have no solid answers.

CoventryCares and other MCOs have been late with reimbursement payments. Since the MCOs testified earlier this year before a legislative panel several of the issues have been fixed, according to the Cabinet for Health and Family Services and ARH president Jerry Haynes.

But, CoventryCares has refused to extend its contract with ARH past May 4. Coventry blames the state for failing to set compensation standards for the new privatized Medicaid system and says it has an unfair number of Medicaid patients since another MCO, Kentucky Spirit Health, has not been forced to contract with ARH.

In a letter from Coventry Health Care president Timothy Nolan to Haynes, he writes:

We have learned that the Commonwealth help another managed care organization (MCO) to a different standard by allowing them to exclude ARH from its network. This disparity resulted in an unprecendented movement by higher-risk members from the other MCO to Coventry.

Haynes told WFPL if no agreement is reached by Friday, some of the 25,000 Coventry members served in Eastern Kentucky will be affected.

“Patients going forward will have to seek services outside of ARH, and of course we are the largest in eastern Kentucky.”

Haynes further said ARH will be forced to eventually cut hundreds of hospital positions.

ARH has proposed two quick fixes, he said: putting Coventry members back into a public Medicaid system, or extending the contract temporarily.

Judge Karl S. Forester has ordered ARH and Coventry to meet tomorrow by 9 am Thursday to resolve “the many issues described in the papers filed by the plaintiff.”

The hearing is scheduled for 9:30 am on Friday in Lexington.

Devin Katayama

Devin Katayama host middays for WFPL and reports on education and other Louisville issues.

@DevinWFPL

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