Representatives of the state's health department and various hospital executives say almost two years later they are still having payment issues with Medicaid managed care organizations.
Speaking before a House budget subcommittee on health issues, the two groups described situations in which payment for care they administrated months ago were still outstanding claims.
Scott Lockard works in the Clark County Health Department and told lawmakers the state public health department was still owed more than $18 million in late payments. More than $14 million of that is with Kentucky Spirit, which is trying to break its contract and leave the system.
But he added that conversations about those payments are ongoing.
A bill requiring Kentucky Medicaid managed care operators publish a list of prescriptions and reimbursement prices on Wednesday passed a state Senate committee, following prodding from independent pharmacists asking for access to pricing standards before they fill prescriptions.
The group of independent pharmacists told lawmakers that they are still having trouble with reimbursements from the state's Medicaid managed care operators. And they said they were also still being dramatically undercut on prescription reimbursements when they did receive them.
Pharmacist Jonathan Van Lahr said his goal was to see transparency in the process.
"We are not asking to be paid exorbitant prices for these medications we dispense, just not to lose money. Or at least, let me know I'm going to lose money before I fill it," he says.
The chairman of a Kentucky Senate committee is promising to file legislation aimed at preventing Gov. Beshear from setting up two major pieces of the federal health care law without legislative approval.
The Courier-Journal reports Senate Health and Welfare Committee Chair and Louisville Republican Julie Denton says she doesn’t want the Governor to be able to unilaterally establish a new statewide health care exchange or expand Medicaid services to more Kentuckians. Denton and other Obamacare opponents say the state can’t afford the exchange or expanded Medicaid offerings.
A new policy by a statewide Medicaid operator has independent pharmacists up in arms again. Earlier this year, pharmacists were the first group to alert lawmakers to problems with the managed care system. But they failed to get a bill protecting their co-pays signed into law.
Struggling Medicaid operator Kentucky Spirit has followed through and is suing to end its contract with the state. Kentucky Spirit announced last week it was leaving the commonwealth, because it could not operate without massive losses. Now, it is suing in Frankfort courts to make it official.
The departure of one of three statewide Medicaid operators next year is once again raising concerns about adequate medical coverage in parts of the state. Earlier this year, coverage was one of the issues brought up between Coventry Cares, another operator, and hospital chain Appalachian Regional Healthcare in a lawsuit over contract issues.
As the fallout continues from the announced departure of statewide Medicaid operator Kentucky Spirit, many other Medicaid operators are already looking to take their place. Kentucky Spirit announced last week they would break their contract with the state early. State officials say they won’t re-open those statewide contracts to replace Kentucky Spirit until the current contracts expire.
Members of a Christians-only health insurance plan that has been ordered to cease operations in Kentucky should get different policies immediately, the state Department of Insurance advised. The move follows Franklin County Circuit Judge Thomas Wingate's ruling earlier this month that Medi-Share, a Florida-based cost-sharing ministry, can't operate in Kentucky because it doesn't meet the state's insurance code.