Local lawmakers have managed care concerns
Published 11:16 am Tuesday, December 20, 2011
Problems with Kentucky’s new managed health care plan within its Medicaid program have local legislators’ attention as they prepare to enter the 2012 session of the Kentucky General Assembly.
Several lawmakers spoke to members of the Barren River Area Development District on Monday, saying the program needs help.
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“To be quite honest with you, it’s been a nightmare since day one,” said state Rep. Jim DeCesare, R-Bowling Green. “We’ve heard from providers, pharmacies, doctors and other providers as well.”
Kentucky Medicaid contracted with three managed care organizations starting Nov. 1. The state projects the new system will save taxpayers $1.3 billion over the course of the three-year contracts for the managed care organizations.
Managed care focuses on improving health care through coordinated preventive services.
However, there are kinks to be worked out.
State Rep. C.B. Embry, R-Morgantown, said he’s heard from both health care administrators and citizens, and all have had “deep concerns” about managed care.
Embry and DeCesare said they expect managed care to be a topic of conversation when House members meet with House Speaker Greg Stumbo today and Wednesday to address several issues before the session begins Jan. 3.
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“Because of this mess right now, we’re finding that a lot of doctors are saying, ‘You know what, I’m done. I’m through messing with Medicaid patients,’ and that’s a big hole that’s going to have to be filled,” DeCesare said.
On the other side of the aisle, state Rep. Jody Richards, D-Bowling Green, has heard the same problems. “It’s been a nightmare, I will tell you,” Richards said.
Richards added that part of the problem is that managed care organizations that were awarded contracts have yet to pay some of the providers.
“It’s harming some of our small business people, our pharmacists,” Richards said. “We’ve got to do the very best we can to save money, but we can’t put our small businesses out of business while doing this.”
State Sen. Mike Wilson, R-Bowling Green, also raised concerns about the effects on local providers, including independent, local pharmacists. “I’m getting tons and tons of calls,” Wilson said.
Wilson talked about a family who had three children placed in three different organizations. “That’s not right either,” he said. “It’s going to take a long while to get all these bugs worked out, and there’s some real concerns there.”
Other issues addressed Monday were the state’s two-year budget, which will be addressed this session.
“We don’t have a lot of money,” DeCesare said. “It is the hope that we’re going to be able to come out with some budget plan that’ll be fair to everyone, especially the taxpayers of the commonwealth.”
Among those budget issues will be how the state funds its retirement system.
“The one thing we should do for the biennium is fund our retirement systems at 100 percent,” DeCesare said. “If I really had my way, we’d go beyond 100 percent, maybe 105, 110 percent, and the reason I say that is funding at 100 percent for the next five bienniums, we’re still going to go belly up in about 10 years, so we need to go beyond that 100 percent.”
Drug problems will also be addressed. Richards said he plans to introduce legislation banning synthetic marijuana and cannabinoids in the state. State Rep. Johnny Bell, D-Glasgow, said he believes there will be legislation introduced banning the “chalky tablet pseudoephedrine pills.”
Bell said overall, people need to set party lines aside.
“We need to go to Frankfort in January and we need to work in a bipartisan way,” Bell said. “We need to get together and forget about Democrat and Republican and independent, if only for a few months, if that’s at all possible. And I know it is.”