Managed Care Mess

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Updated: 12/15/2011 6:58 pm

Kentucky’s new way of managing Medicaid is raising questions about whether the promised savings are worth the sacrifices.  Health professionals and advocates on the state’s Advisory Council for Medical Assistance voiced a litany of concerns Tuesday which underscore a messy start to the state’s new approach.

 

Three private companies are under contract with the state to manage care of Medicaid services received by 530,000 poor and disabled Kentuckians.  The switch to managed care began on November 1.

 

"We can start making a difference in the health and well being of the members of our health plan,” Jean Rush with Kentucky Spirit Health Plan told the advisory council. 

 

But, the medical professionals, advocates and Medicaid recipients on the panel wee telling a different story.   "Some people are not getting their meds in a timely fashion, some of their meds are not available, especially in the mental health community,” said advocate Oyo Fummilayo.

 

Advocates for the mentally ill wore red to the meeting at the state capitol to protest what they wee as a “ratcheting down” of treatment.  They worry more mentally ill people will end up behind bars, homeless or hospitalized because of managed care.

 

"What you guys need to realize, we don't want to be in the hospital,” said Sheina Murphy, a Medicaid Recipient from Paducah.

 

Murphy is a schizophrenic who depends on her meds to live a stable life.  "With severe mental illness you just can't go playing with meds like that."

 

Child psychiatrist, Dr. Larry Suess, told of a mentally ill boy who went without a drug which helped stabilize him.  "This12 year old tried to hang himself in a closet, with a belt, four days after he did not have medication,” said Suess.

 

Denials of medication, along with slow reimbursements to providers are creating the messy start to managed care.  "We implemented too quickly in my opinion,” said Dr. David Neel.  Neel says the state, hospitals, doctors, patients and the managed care companies were not ready.

 

Still, the private companies overseeing services which make up part of Kentucky’s six billion dollar health insurance program for the needy claim managed care is the right approach.

 

"We are trying to do, make the world better, I mean I understand there are going to be some growing pains, but we are not just about saying no,” said Barbara Witty, CoventryCares of Kentucky./

 

Managed care has been used in 16 Louisville area counties since 1998.  The not for profit organization, Passport, serves 170,000 Kentuckians in that region. 

 

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