Kentucky officials are once again facing the prospect of lawsuits over efforts to expand managed health care within Medicaid. This time, it's Passport Health Plan that is threatening to sue, based on what they call broken rules and promises made to them.
Passport is a group of doctors and other medical personnel that has operated as a managed care operator for decades in Louisville's Medicaid region. Passport is facing competition for the first time next year, thanks to the state awarding contracts to Coventry Cares, WellCare and Humana for that region.
Passport CEO Mark Carter claims that his group was promised 41 percent of the Louisville Medicaid membership, based on their ability to have contracts with nearly every doctor and hospital in the region.
But the state actually assigned Passport only 27 percent of the members. Coventry and WellCare each received 25 percent and Humana received 23 percent. That's a 73 percent reduction in the membership Passport currently manages.
Because of that, Passport has formally asked for the state to stop the process of implementing the new Louisville region contracts until the issue is resolved. And if the state refuses, Passport has threatened to sue.
But Passport Vice President Jill Bell says she hopes it doesn't get to lawsuits.
"Actually we’re committed to working with the state to find a reasonable solution and I’m pleased to let you know that we have been in contact with them, so we hope to reach a resolution very soon," she said.
Passport claims it should receive its potential maximum allotment of 41 percent because it has the best network of agreements with doctors and hospitals, while Humana has to build theirs from the beginning. WellCare also has to build a Louisville network, but operators statewide. Coventry Cares also operates statewide, but has few contracts after their broke many of them. Coventry currently does not have contracts with Kentucky One Health or Norton Hospitals, two main hospital networks in the region.
Regardless of outcome, Bell said Passport will aggressively market itself to Medicaid to sign up with them during open enrollment.