What to to know about changes to Medicaid co-pay in Kentucky.
Scott Utterback, Louisville Courier Journal
FRANKFORT — A recent award of $8 billion in state Medicaid contracts by the administration of Gov. Matt Bevin came under fire on two fronts by lawmakers on Monday.
They were angered over the seeming haste to award the contracts, as well as the administration’s attempt to bypass a legislative committee that’s supposed to review them.
On Monday, the General Assembly’s Government Contract Review Committee, which has only advisory power, voted unanimously to reject the contracts after finding the Bevin administration failed to give them the contracts in advance.
The contracts involve managed health care for more than 1 million Kentuckians covered by Medicaid.
Sen. Stephen Meredith, a member of the committee, said the Bevin administration claimed such contracts were exempt from review by the committee, a claim the committee determined was wrong.
So, the administration sent the contracts to the committee for approval, but only after it had already awarded them to five private health insurance companies, Meredith said.
“It’s like we’re being strong-armed into doing something,” said Meredith, a Leitchfield Republican, in explaining the committee’s unusual decision to reject the contracts.
The awards already have stirred controversy and a promise by incoming Gov. Andy Beshear to review them after he’s sworn in Tuesday.
Meredith said Finance Secretary William Landrum, whose cabinet oversaw the contract awards, could still overrule the committee’s decision on Monday, during what’s likely his last day on the job as a Bevin appointee.
But he said the administration’s attempt to bypass the committee upset the members.
“We should have seen these contracts before they were awarded,” Meredith said. “If we’re not seeing these contracts, I’m truly wondering about what else we’re not seeing.”
Meanwhile, the contract award stirred controversy on another front Monday when administration officials appeared before the Medicaid Oversight and Advisory Committee, where lawmakers demanded to know why the contracts were awarded in apparent haste and why lawmakers were not consulted about details that affect their communities.
“This looks like, from my perspective, this was a very rushed procedure with the intention of trying to limit any legislative input,” committee co-chairman Meredith told Adam Meier, secretary of the Cabinet for Health and Family Services, which runs Medicaid for the state and was involved in drawing up the contract proposals. “I’ve got some great concerns with the process.”
State Sen. Morgan McGarvey, a Louisville Democrat and Senate minority leader, expressed similar frustration.
“Why has there been such secrecy around this process, and why was there an $8 billion contract award issued after the election?” McGarvey asked Meier.
Meier defended the contract process, saying confidentiality is necessary for proper contract review and award.
“They’re not secret, they’re confidential,” he said.
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He said the contract bids were independently evaluated by a five-member committee that scored each one for how well it met state specifications.
And he said administration officials have been working for months on the contract awards.
“The idea that this was rushed is absurd,” Meier said.
Still, lawmakers on the Medicaid oversight committee continued to pepper Meier with questions and criticism — focusing particularly on why the state chose to remain with five contractors when federal regulations allow it to choose as few as two outside vendors.
The federal government provides about 80% of the funds for Kentucky’s $11 billion-a-year Medicaid program.
Lawmakers have repeatedly criticized five companies as too many, arguing it presents health providers with competing rules, regulations and multiple forms to fill out in order to get paid for treating Medicaid patients.
They have suggested no more than three outside managed care companies, and Meredith has filed a bill that would limit the number to three.
“This body has made it clear, abundantly clear, that we expect three,” said Sen. Danny Carroll, a Paducah Republican. “Why do we have five? Is there something I’m missing?”
Meier said the state settled on five to allow for more competition.
“I don’t see us trying to limit competition,” he said.
But that answer didn’t sit well with lawmakers on the committee, including Meredith, a former hospital CEO in Central Kentucky, who insisted five contractors is excessive and overly complicated for hospitals, doctors, pharmacists and other health providers.
“Here we have five,” Meredith said of the contract award. “That places a tremendous burden on all health care providers.”
The administration announced the contract awards Nov. 27. Companies that won contracts are: Aetna Better Health of Kentucky, Humana Health Plan and Wellcare Health Insurance of Kentucky, all of which hold existing contracts with the state, and two newcomers, United Healthcare and Molina Health Care.
Left out were two companies that hold existing Medicaid contracts, Anthem and Louisville’s Passport Health Plan, the state’s first and longest running managed care provider.
The five-year contracts take effect July 1, but Anthem and Passport have announced they will file challenges to the award.
Meredith said Monday the incoming Beshear administration will have the power to review the awards.
At least one lawmaker, Rep. Jason Nemes, a Louisville Republican, has expressed concern about the awards and is calling on Beshear to scrutinize them.
Meredith said he wouldn’t be surprised if the dispute ends up in court.
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