Medicaid

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.

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