Managed Care Implementation Delayed to Nov. 1st.

Medicaid Managed Care Implementation Extended until Nov. 1

Cabinet officials will manage Medicaid program to balance budget by the end of the fiscal year

FRANKFORT, Ky. (Sept. 19, 2011) — Cabinet for Health and Family Services (CHFS) Secretary Janie Miller today announced that the implementation date for Medicaid Managed Care, targeted for Oct. 1, 2011, will be extended one month, an option provided in the contracts with managed care organizations. The Cabinet has granted the extension in response to a request from the Kentucky Hospital Association (KHA), which has assured the Cabinet that a one-month extension to Nov. 1, 2011 will allow hospitals adequate time to sign contracts and prepare for implementation.

Discussions have been ongoing with hospital representatives over the last 2 ½ months about the expansion of managed care to Medicaid recipients in the 104 counties not covered by Passport. The short time frame for managed care implementation has been the primary concern expressed by the hospitals.

"We have made great progress in Medicaid Managed Care since we first announced the contract awards in July,” Secretary Miller said. "Thousands of providers have signed up with the managed care organizations and successful readiness reviews have been conducted, but we still need the hospitals to sign contracts before we can implement managed care across the commonwealth. The hospitals have told us they need one more month to prepare and this complies with their request.”

In July, Governor Steve Beshear announced that Kentucky had awarded four contracts to managed care organizations (MCOs) to provide health care services to Medicaid recipients statewide. Three of those contracts are with new vendors. Coventry Cares of Kentucky, Kentucky Spirit Health Plan and WellCare of Kentucky will serve more than 560,000 recipients across the state that live outside the 16-county region served by Passport, which provides managed care to 170,000 Medicaid recipients.

The managed care strategy emphasizes a holistic approach to health care, which can be particularly effective in helping coordinate the care delivery needs of individuals with a variety of health issues and multiple health care providers. The goal of the contracts will be to improve health care outcomes, particularly as it relates to diabetes control, coronary artery disease, colon cancer, cervical cancer, behavioral health, prenatal care and oral health. The contracts also place a high priority on reducing inappropriate use of services, such as unnecessary ER visits; improving care coordination, especially for individuals with chronic illnesses; promoting wellness and healthier lifestyles; and lowering the overall cost of health care.

Earlier this month, CHFS received approval from the Centers for Medicaid and Medicare Services (CMS) to operate a Medicaid managed care organization waiver program. The waiver allows Kentucky to implement a mandatory managed care program for virtually all Medicaid recipients in the state outside of the Passport region, which operates under a separate CMS waiver.

The expansion of Medicaid managed care to cover the entire state required federal approval from CMS, which the state received on Sept. 8, 2011. The move to statewide managed health care will save taxpayers $375 million in General Funds and $1.3 billion in all funds over the course of the new, three-year contracts.

The one-month extension will not have a significant effect on the managed care program savings for this fiscal year. The Department for Medicaid Services will manage the impact within the overall Medicaid program budget.

"The Medicaid program is made up of many moving parts, so handling a one-month deferral in savings is very manageable,” said Acting Medicaid Commissioner Neville Wise. "The contracts with MCOs included the provision for an extension to Nov. 1, so the department is fully prepared to manage the short-term, reduced savings.”

For more information on becoming a Medicaid provider visit the KCNPNM MCO information page.