, Corbin, KY

State News

June 14, 2013

Mixed reviews on managed care


FRANKFORT - Kentucky’s Medicaid Commissioner says managed care is clearly improving health outcomes in the state, but some Kentucky lawmakers remain unconvinced managed care is working as it should.

Lawrence Kissner told members of the Program Review and Investigations Committee Thursday that the new way of delivering state and federally funded healthcare to the poor and disabled is producing more preventive screenings and improved health while the state is methodically resolving prompt pay issues for providers.

He also defended Gov. Steve Beshear’s decision to expand Medicaid to about 300,000 “working poor” people under provisions of the federal Affordable Care Act known to some as Obamacare.

His evidence for the latter statement met with skepticism from one Republican on the committee, Sen. Tom Buford, R-Nicholasville.

Kentucky moved last year from the traditional fee-for-service model of paying medical providers for Medicaid services to a managed care system where the state contracts with Managed Care Organizations on a per-patient, annual fee and the MCO then negotiates rates they will pay to medical providers. The intent from the state’s perspective is to save money and slow the rate of Medicaid costs.

But the new system met with widespread complaints from hospitals, pharmacies and other providers who contend the MCO’s are slow to pay.

Kissner said the state has resolved 95 percent of provider claims disputes and found only 4.5 percent of the complaints were due to prompt pay issues. Those are now being investigated by the Department of Insurance.

He said the state is using outside auditors to review performance of managed care and payment issues and MCOs which are found deficient in promptness of pay face penalties. Kissner said two of the MCOs, Kentucky Spirit and Coventry have been cited for failure to make prompt payments.

But lawmakers reserved most of their questions for Kissner’s defense of Medicaid expansion.

Kissner began by reeling off a long litany of health statistics showing Kentucky as one of the unhealthiest states in the nation.

Expanding Medicaid to those who earn 138 percent of the federal poverty line, Kissner said, will provide health care to about 300,000 people who can’t afford health coverage. Meanwhile, he said, the federal government pays for 100 percent of the cost of expansion for three years and 90 percent after 2020.

Kissner said 138 percent of the poverty level “is about equivalent to minimum wage, so it is the working poor who couldn’t afford insurance that will be covered.”

He also said any additional costs to the state General Fund will be more than offset by the economic impact during the years when the federal government pays all the costs. According to studies cited by Beshear when he announced expansion of Medicaid, the state will benefit from lower costs in indigent care subsidies, creation of jobs and economic activity produced by the expansion.

After the federal match drops back to 90 percent, the difference will equal out, Kissner said.

Buford wasn’t convinced and offered several criticisms of the ACA, including insurance companies offering “skinny plans,” basic low-cost plans which provide little coverage, to the possibility some employers will reduce hours to avoid the requirement they pay insurance under the law.

He noted recent studies which show Kentucky has too few primary care providers for current needs and that about one-third of physicians won’t serve Medicaid clients.

When finished, Buford told Kissner his remarks were “more of a commentary, I guess, than a question.”

But Kissner said study after study shows a correlation between health status and health insurance coverage and expanding Medicaid should improve Kentuckians’ overall health while providing a net economic benefit to the state.

Several lawmakers asked Rep. Fitz Steele, D-Hazard, the committee chair, if there will be future opportunities to question Kissner.

“They’ll be with us at every meeting throughout the rest of the year,” Steele responded.

Kissner later said he’s happy to come back before the committee.

“I welcome the opportunity to spread the news that we are driving better health care outcomes,” Kissner said.

RONNIE ELLIS writes for CNHI News Service and is based in Frankfort. Reach him at Follow CNHI News Service stories on Twitter at

Text Only
State News
  • Committee seeks explanation of selenium reg discrepancies

    A committee of state lawmakers wants the Energy and Environment Cabinet to explain apparent inconsistencies between its position and that of the U.S. Fish and Wildlife Agency on a new regulation governing how much selenium mining operations may release into Kentucky streams.

    April 22, 2014

  • Healthcare signup in state extended

    While the national health exchange established by the Affordable Care Act — known to some as Obamacare — suffered glitches, crashes and delays, the Kentucky-run exchange, Kynect, was often used as a national model.

    April 4, 2014

  • Kentucky budget passed with little debate

    The Kentucky General Assembly, divided between chambers along party lines, overwhelmingly passed a $20-billion, new two-year budget not only on time but with almost no debate.

    April 1, 2014

  • Lawmakers agree on snow bill

    Kentucky school officials, parents and students finally have what they’ve been asking for: A bill to allow them to get out of school before the summer fully sets in, even if they don’t make up some of the days they missed during the severe winter.

    March 31, 2014

  • Tensions rise during budget negotiations

    Tensions increased Friday between the Republican Senate and Democratic House over continuing negotiations on a new, two-year budget. It even got personal at times.

    March 31, 2014

  • Kentucky Power plan a potential landscape-changer

    Electrical ratepayers, local governments and those employed in the coal industry might have a hard time understanding the complicated transaction through which Kentucky Power Company is purchasing half the generating capacity of a coal-fired West Virginia plant.

    March 28, 2014 2 Stories

  • Senate passes budget with no locked-in gas tax hikes

    The state Senate on Tuesday passed its version of a two-year revenue measure, and unlike the House version, it does not lock in gas tax increases.

    March 26, 2014

  • House passes bill aimed at saving Big Sandy Plant

    Backers of a bill to require the Kentucky Public Service Commission to “reconsider” its previous order approving Kentucky Power’s purchase of a West Virginia generator say all they are asking “is for them to take a second look and look at all the facts.”

    March 26, 2014 1 Story

  • Judge: Companies can’t use eminent domain for pipeline project

    Franklin Circuit Judge Phillip Shepherd on Tuesday ruled that companies building a natural gas liquids pipeline across parts of Kentucky cannot invoke eminent domain to force private property owners to provide easements.

    March 26, 2014

  • Still no snow day solution from lawmakers

    Senate and House negotiators, working on a bill to give school districts flexibility in making up snow days, each accused the other of moving the goal posts – but it’s the local school districts who may be penalized.

    March 25, 2014

Front page
Featured Ads
AP Video
Hyperlocal Search
Premier Guide
Find a business

Walking Fingers
Maps, Menus, Store hours, Coupons, and more...
Premier Guide