Medicaid managed care contracts awarded for Jefferson, surrounding counties

The Commonwealth of Kentucky has signed contracts with Coventry Cares, Humana, Passport and Wellcare of Kentucky to provide health care services to approximately 175,000 Medicaid recipients in Louisville and 15 surrounding counties. These managed care organizations (MCOs) will provide services in Region 3, which is comprised of Breckinridge, Bullitt, Carroll, Grayson, Hardin, Henry, Jefferson, Larue, Marion, Meade, Nelson, Oldham, Shelby, Spencer, Trimble and Washington counties. The contracts are for an initial 18 months with four, one-year renewal options. The new contracts will take effect Jan. 1, 2013.

Earlier this year, the Centers for Medicaid and Medicare Services (CMS) advised the Cabinet that Region 3 could no longer operate with a single managed care provider. Beginning Jan. 1, 2013, CMS requires that Medicaid recipients in Region 3 have a choice of more than one provider for health care services.

“The managed care approach is familiar to Medicaid recipients in the Jefferson County area, but having a choice of managed care organizations is new,” said Cabinet for Health and Family Services Secretary Audrey Tayse Haynes. “Passport has been a good partner and has served the region’s recipients well for 15 years, but the federal government now requires that individuals have a choice of providers. The Cabinet is pleased with the level of interest from the managed care community and we look forward to their work on behalf of our Department for Medicaid Services and the individuals who rely on Medicaid for their health care coverage.”

The Cabinet for Health and Family Service’s Department for Medicaid Services has contracted with Passport to be the sole provider of Medicaid-covered services in Region 3 since 1997. Medicaid recipients in the remaining 104 counties in the Commonwealth have a choice of three MCOs that have been providing managed care services since Nov. 1, 2011. Over the last four fiscal years, the Medicaid cost for Passport members was reduced 6.5 percent even though health care costs in the southern region of the United States have increased an average of nearly 3.5 percent.

The new contracts maintain those savings for the biennium, and protect the Medicaid program against rising health care costs over the next 18 months. The new contracts will include behavioral health services, as is the case in Medicaid managed care contracts for the rest of the state. Medicaid recipients and providers in Region 3 will soon receive a letter about these changes. The Department for Medicaid Services will enroll Medicaid recipients in Region 3 with the MCO that is determined by a high-tech matching system to be the best fit based upon available provider networks and any special health care needs the individuals may have. Members will receive notice by early November of the MCO with which they have been matched. Upon notice of this match, Medicaid recipients will have 30 days to select a different MCO before the Jan. 1, 2013 effective date of coverage. The Department for Medicaid services will provide information about how Medicaid recipients can choose the best MCO for their needs. Medicaid recipients who wish to switch to a different MCO after Jan. 1, 2013, will have another 90 days in which to request a change.

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Ben Keeton

Publisher at Medical News
Ben is the publisher of Medical News and focuses on the business of healthcare in Kentucky.
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