MCO

The organizations the Commonwealth contracts to provide Medicaid insurance benefits are under fire from regional hospitals and doctors for late or missing payments.

In western Kentucky, that fire has focused on managed care organization Kentucky Spirit.  The state is responding with a series of public meetings to relieve tensions. 

Western Kentucky public health departments could expect more than a million dollars in reimbursements from Medicaid-Managed Care Organization Kentucky Spirit. 

Kentucky contracts with MCOs to offer insurance benefits to Medicaid users. 

Early last week, Franklin County Circuit Judge Philip Shepard issued a 13-page order that the Missouri-based care provider pay $8 million to the state. 

This comes after the Commonwealth claimed Kentucky Spirit never paid health departments for Medicaid programs.

  The Hopkins County Board of Health may learn in two weeks whether they'll settle an ongoing dispute with a Medicaid Managed care Organization.  Board Director Jack Morris said a judge will decide in two weeks whether Kentucky Spirit is liable for the $190,000  owed to the Health Department for services provided in state schools. Kentucky Spirit claims it didn’t understand the obligations despite signing a binding three-year contract with the state. Board Chairman Dr. Tristan Linesberry said the organizer’s position is an untenable situation.

governor.ky.gov

Gov. Steve Beshear has vetoed a bill sponsored by House Speaker Greg Stumbo that would require prompt payment in the Medicaid managed care system. 

The governor was expected to veto the bill, claiming it would cost the state too much money.

But in turn, Beshear says he will implement the spirit of the bill, including allowing the Department of Insurance to investigate late payment claims. Beshear also promised the administrative side of the managed care system would work better.

A recent decision by a statewide Medicaid operator has independent pharmacists upset again

Back in January, it was a group of pharmacists who blew the door off the hinges when it comes to problems with Kentucky'’s Medicaid managed care system.