Medicaid

Kentucky Governor Steve Beshear is set to announce whether or not he’ll expand Kentucky’s Medicaid program.

The Governor’s office says Beshear will share his decision Thursday at a 1:30 p.m. eastern time news conference at the state capitol building.

Under the federal Affordable Care Act, each state has the option of expanding its Medicaid services to those earning less than 133 percent of the poverty rate. The federal government has agreed to pay each state’s additional costs related to expansion for the first three years, with Washington picking up 90 percent of the tab each following year.

Some conservatives and Tea Party activists have called on Beshear not to agree to the expansion, saying the commonwealth can’t afford any additional costs.

Supporters say it’s a once-in-a-lifetime opportunity to extend the program to a wider number of Kentuckians who are struggling with high health care costs.

Health departments across Kentucky continue to make cuts because of a dispute between the state and a managed-care company hired to help serve Medicaid patients.

The Lexington Herald-Leader reports the cuts include laying off workers, ending school health programs and decreasing clinic hours.

Kentucky Health Departments Association President Scott Lockard told the newspaper that health departments cut 53 workers last year, and another 95 have been cut this year. He said some departments are facing furloughs through July 1.

The Madison County Health Department, for example, announced the end of its school nurse program in February. Fayette County's health department ended that program last year.

Previous naysayers are coming around to the idea of expanding TennCare. Even while criticizing the Affordable Care Act, they say pulling more poor people into the state’s Medicaid program could have some upsides.

Other Republican-led states have taken the leap, even as Governor Bill Haslam continues to weigh the pros and cons.

House Majority Leader Gerald McCormick says at first, all he could see was that after three years, the state would have to start picking up part of the tab.

“There are some other facts that have come to light since then that would offset some of those expenses. That’s why I have an open mind about it.”

Tennessee Gov. Bill Haslam says he will make up his mind on whether to expand the state’s Medicaid program by the end of the month. He says he’ll leave time for the state legislature to consider his decision.

There’s no pressing deadline except that the state legislature intends to wrap up work in April and Haslam needs lawmakers to sign off either way. If he does go along with the Affordable Care Act and expand the state’s Medicaid program, it could take a lot of convincing.  

“If the decision is no, then their discussion is short I think. If the decision is yes, then I think they’ll need a decent amount of time to discuss that,” said the Republican Governor.

Two Republican lawmakers are still trying to advance bills that would bar the state from expanding Medicaid. They argue the state still can’t afford it even though the federal government pays the bill for the first three years.

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.

Denton’s bill would make such moves contingent on General Assembly approval. Gov. Beshear has already taken steps to create a statewide health care exchange by 2014, which would allow those who don’t get insurance at work to buy a plan from a private company and receive government subsidies in the process.

The Medicaid expansion would allow those earning less than 133 percent of the poverty rate to qualify for the program. Beshear says he is still considering the Medicaid expansion, while House Speaker Greg Stumbo says he fully supports the move.

The Speaker of the Kentucky House says it’s a no-brainer for Kentucky to expand its Medicaid program under the Affordable Care Act.

Under the health care law, states can expanded their Medicaid rolls to 138 percent of the poverty line, with the federal government picking up the tab for three years. 

Kentucky Governor Steve Beshear has yet to decide whether Kentucky will expand, saying he will calculate costs after 2017, when the feds pay only 90 percent of the expansion.

But Democratic House Speaker Greg Stumbo says he's encouraging Beshear to commit to Medicaid expansion now.

“I think it would be a penny wise and a pound foolish not to find the money,” Stumbo says.

Weeks after their announced departure from Kentucky’s Medicaid managed care system, operator Kentucky Spirit and the state are still locked in a legal battle.

Both sides have sued each other, blaming the other for the situation. Kentucky Spirit announced their departure, scheduled for the middle of 2013, due to massive losses in the system.

In an interim committee meeting Tuesday, Kentucky lawmakers asked for an update on what the state hoped to recoup financially because of Kentucky Spirit’s decision.

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.

The CEO of a major Medicaid managed care company (MCO) is criticizing Kentucky for the way the state deals with businesses like his. Michael Neidorff is the CEO of Centene, which operates Kentucky Spirit, one of three statewide MCOs that has managed Medicaid patients for the state since last year.

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