The monumental problems that developed when the state shifted its Medicaid administration to three managed care companies last November may not have been inevitable, but they certainly have been painful for health care providers across the commonwealth in the past three months.
That’s why state Auditor Adam Edelen correctly responded to complaints about the reimbursement of claims (and the denial of some) by the three companies by sending them letters of inquiry last month. His investigation of CoventryCares, WellCare and Kentucky Spirit is continuing. And in Frankfort, lawmakers have jumped into the debate with questions for both providers and the contractors in public hearings.
On Wednesday, officials from the three companies (which administer all Medicaid managed care clients outside of Louisville and 15 surrounding counties) answered questions from the Senate Health and Welfare Committee. During that session, the blame game was in full swing, with the companies — and Republican senators — seeming to give the Beshear administration the lion’s share of criticism for the situation.
It is far too early to reach such a conclusion.
State Sen. Joe Bowen, R-Owensboro, asked: “You all didn’t have the opportunity for a soft opening, you had a grand opening and more people showed up than you anticipated. I mean is that fair to say?”
That grand opening to which he referred was Nov. 1, one week before Gov. Steve Beshear, a Democrat, was re-elected by an overwhelming majority. The final plans for the managed care contracts had been announced by the administration on Oct. 15.
WellCare president Mike Minor responded by saying, “I would say there was an extreme urgency between Oct. 15 and Nov. 1 to get contracts done, and it was terrific to see the provider community had the urgency to get that done.”
The switch to managed care was a responsible move by the Beshear administration, which predicts substantial savings in the $6-billion-per-year Medicaid program.
And remember, just three and a half months have passed since the changes took effect, barely time for some of the claims to be processed. Sen. David Givens, R-Greensburg, questioned whether Medicaid officials had waited too long before responding to the complaints of providers. “At what point are you going to lose your patience?” Sen. Givens demanded.
Clearly answers aren’t going to come from this sort of partisan exercise. Let’s wait for the auditor’s office to provide some clearer guidance about what went wrong and, more important, how to keep it from continuing.


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