Health Care
4:00 pm
Mon October 22, 2012

Medicaid Issues Leave Heavy Burden on WellCare

The departure of one of three statewide Medicaid operators next year is once again raising concerns about adequate medical coverage in parts of the state. Earlier this year, coverage was one of the issues brought up between Coventry Cares, another operator, and hospital chain Appalachian Regional Healthcare in a lawsuit over contract issues. At the time, state officials pointed to the other two operators as proof of coverage. But now one of those operators, Kentucky Spirit, is leaving next July. And with Coventry still without contracts for many doctor and hospital groups in the eastern part of the state, Wellcare is essentially left as the only operator. Kentucky Voices for Health Executive Director Jodi Mitchell says that puts pressure on WellCare to pick up the slack.

"But I think that it's going to be carefully watched to see if WellCare is able to maintain enough providers in their network to care for these Medicaid members," she says.

Choice is one of the key terms from the federal government when states turn to a managed care system. And if WellCare isn't able to handle the bulk, it could put the program at risk in a lawsuit. Mitchell says having only one operator in a needy region like Eastern Kentucky is possible, but comes with high pressures the other two operators have failed to handle.

"I think that is what we are concerned with, that if it has happened to the other two, it is likely to have a similar effect, maybe not the same because they all manage their contracts somewhat differently, but it's likely to have a similar effect," she says.

State officials say they will not re-open statewide contract bidding until the end of next year, when contracts for future years are bid on. Two Louisville region operators, Passport Health Plan and Humana, are interested in expanding statewide at that time.