FRANKFORT — The state plans to be up and running with its new managed care delivery of Medicaid services by Oct. 1 – but as of last week, only 15 or so of the state’s hospitals had signed on with one of the three managed care providers.



Following years of steep increases in the Medicaid budget, the legislature last spring passed a plan to allow private, for profit managed care organizations to deliver medical services to Medicaid clients for a contracted per-patient fee. Three MCOs have been approved to serve all of the state outside a 16-county area surrounding Louisville where managed care is already provided by not-for-profit Passport Health. Clients are to be assigned to one of those three by October 1, said Cabinet for Health and Family Services Secretary Janie Miller Monday.



Miller appeared before the legislature’s Medicaid Oversight and Advisory Committee and as she has in the past faced prolonged questioning from Republican senators – and one Democratic representative concerned about the impact on rural areas.



While Republican senators Dan Seum and Julie Denton, both of Louisville,  quizzed Miller about the time line of implementation and the signing up of direct providers by the MCO networks, Rep. John Will Stacy, D-West Liberty, wanted to know how many rural hospitals had signed up.



Miller said the state has approximately 109 hospitals but only 15 had joined one of the MCO networks “as of last Wednesday.” However, she said the cabinet is fielding calls from doctors and hospitals indicating more will soon join MCO networks.



She said she wants to see about 89 hospitals join one or more of the three networks but the contracts provide for “out of network” services if enough hospitals don’t join in rural or isolated areas.



Seum questioned Miller about the confusion among doctors and hospitals who have complained to him, saying they have been contacted but haven’t seen actual contracts and don’t know “how to play the game.” Nor do they know whom to contact to get answers to their questions, Seum said.



Miller responded that letters have been sent out to all providers as well as clients and those letters include numbers to call if they have questions. Miller said the cabinet has actually been surprised by the relatively small number of calls it’s received.



She said MCOs initially focused their network recruitment on primary care providers and have now turned to hospitals and pharmacies.



Miller said the cabinet will at first assign clients to MCOs based on the networks which include the providers they’ve been seeing or the specific services the client requires. But clients, or members as she calls them, won’t be restricted to the MCO to which they are assigned. They may immediately choose another network or they may stay within the assigned network but retain the option to move for 90 days.



Miller said the primary focus of the cabinet has been to maintain the “continuity of care” for Medicaid clients, wishing to ensure there is no break in their medical care as the state moves to the new system which is projected to save the state budget about $1.3 billion over three years.



She said the goal is to have membership cards issued to all clients by Oct. 1 and for the MCOs to begin managing medical care by that point. Pressed by Denton about whether it would be wiser to delay full implementation by a month, Miller said the contracts allow for that but the cabinet continues to believe it can be ready by Oct. 1.



Ronnie Ellis writes for CNHI News Service and is based in Frankfort, Ky. He may be contacted by email at rellis@cnhi.com. Follow CNHI News Service stories on Twitter at www.twitter.com/cnhifrankfort.