Tagged: Medicaid Managed Care

The dispute between an Eastern Kentucky hospital chain and private Medicaid operators has lawyers arguing distance versus drive time.

Under state regulations, a private Medicaid operator cannot sign up a patient unless it has a doctor or hospital within 60 miles of that patient's home. But that distance is measured as the crow flies and the state doesn't take into account narrow and winding Appalachian roads. For many patients, it may be faster to visit a doctor that's 70 miles away than it is to visit one that's 50 miles away.

A continued contract dispute between an Eastern Kentucky hospital network and the largest private Medicaid operator in the state is leading to confusion in the region.

CoventryCares and Appalachian Region Healthcare are locked in a legal dispute over a new contract, with another court hearing scheduled for tomorrow.

After months of mounting problems, State Auditor Adam Edelen says he will launch a full investigation intoKentucky’s statewide Medicaid Managed Care system.

Edelen created a Medicaid task force in February after taking a first look at the managed care system. He also gave recommendations to managed care companies, health care providers and the state on how to make the system run better in the future.

But with clashes between private Medicaid companies and healthcare providers ongoiong, Edelen wants to take a stronger look into the system.

State officials have not yet given private Medicaid operators permission to do business in the Louisville area, but that hasn’t stopped one company from trying to make inroads.

State officials have not yet given private Medicaid operators permission to do business in the Louisville area, but that hasn't stopped one company from trying to make inroads.