Rushed transition to managed care is cautionary tale for other states, especially those with large rural populations

Kaden Stone and mother, Angelina Alcott (Photo by Julie Bergal)

Since Kentucky's abrupt revolution to a Medicaid managed-care usage in 2011, problems own been extensive amid patients and providers, highlighting the dangers representing other states, and especially rural ones, around a rushed transition to this standard exclusive of sufficient homework or mistake. Such problems can multiply as Kentucky and a quantity of other states enlarge Medicaid under Obamacare.

“The Kentucky argument is a harbinger of come again? Can occur what time states don’t allow an adequate amount stage and give over sufficient assets to strengthen the Medicaid agency’s mistake size and systems — or develop strong contracts and care-monitoring systems from nick if they haven’t contracted with managed thought campaign or,” Debra Lipson, a senior researcher next to Mathematica Policy Research, told Jenni Bergal of Kaiser Health News, script representing The Washington Post.

Patients in Kentucky's managed-care usage complain of being denied management or having to drive long distances to discovery doctor's contained by their campaign interact. That's especially actual of fill with in rural areas, such as Darlene VanHoeve in southeastern Kentucky, Bergal writes. VanHoeve has a son who needs management representing autism next to a focus an hour away, but managed-care solidify WellCare of Kentucky wouldn't salary representing these services despite a physician's order, aphorism the focus wasn’t in its interact. During Greensburg, 8-year-old Kaden Stone loves in concert baseball and riding his bike, but as a effect of ingrained bowel problems to facilitate own requisite dozens of surgeries and procedures, he needs PediaSure, his care for told Bergal. Yet, managed-care solidify Coventry Cares stopped paying representing it after everything else fall, aphorism it was not “medically compulsory.”

Hospitals and doctors own continuously expressed complaints around denied or delayed payments from managed thought companies. Kentucky physical condition officials admit at hand own been problems interrelated to the breakneck switch to managed thought in 2011, writes Bergal, but they claim to facilitate claims are promptly being paid promptly. They furthermore claim to facilitate providers touch with managed-care companies to retrieve outstanding payments and to facilitate thought quality has improved in the state.

Advocates representing the mentally not well argue to facilitate the thought usage representing them has deteriorated, aphorism campaign own denied patients' long-standing prescriptions, forcing a quantity of society mental physical condition centers to limit or cancel programs, says Bergal. “The total issue has been a tight spot,” Sheila Schuster, executive director of the Kentucky Mental Health Coalition, told Bergal.

To the same extent Medicaid rolls enlarge, persons already in the encode can be close improbable of a quantity of of the recipe preventive services built-in in the modern physical condition law, says a contemporary study available in Health Affairs.

States to facilitate own phased in managed thought more gradually own been more winning, so Kentucky's story is a cautionary tale representing other states. “It was a major challenge,” Michael Murphy, chief executive of Aetna-owned Coventry Cares, told Bergal. “Obviously, we learned a a small number of coaching in Kentucky.” Perhaps this tale will keep other states from having to gain knowledge of coaching too.