Managed-care shift hard for Kentucky
GREENSBURG, Ky. — Kaden Stone loves playing baseball, riding his bike and watching “Duck Dynasty” on TV at his red brick ranch-style house in rural, south-central Kentucky.
Despite his energy, the tiny 8-year-old boy with a crew cut and missing front tooth can't eat much, the result of congenital bowel problems that have required dozens of surgeries and procedures. He needs PediaSure, says his mother, who was shocked when Kaden's Medicaid managed-care plan stopped paying last fall for the expensive nutritional drink, saying it was not “medically necessary.”
“We couldn't believe it, because he had only gained four pounds in a year, and the doctor says he had to have it because he wasn't flourishing,” Angelina Alcott said. “He's only 3½ feet tall and 48 pounds.”
Ever since Kentucky rapidly shifted patients from traditional Medicaid to private health plans that manage their care for a set price, problems have been widespread. Patients complain of being denied treatment or forced to travel long distances to find a doctor or hospital in their plan's network. Advocates for the mentally ill argue that the care system for them has deteriorated. And hospitals and doctors say health plans have denied or delayed payments.
Experts warn that what happened in Kentucky should be a cautionary tale for other states that rush to switch large numbers of people enrolled in Medicaid, the state-federal program for the poor and disabled, to private managed-care plans in hopes of cutting costs and improving quality. Nearly 30 million Americans on Medicaid now belong to a private health plan, as states move away from the traditional program that paid doctors and hospitals for each service they provided.
Beginning in January, millions more will become eligible for Medicaid under the federal health law, and many will be placed in managed care.
“The Kentucky case is a harbinger of what can happen when states don't allow enough time and devote sufficient resources to strengthen the Medicaid agency's oversight capacity and systems — or develop strong contracts and care-monitoring systems from scratch if they haven't contracted with managed care plans before,” said Debra Lipson, a senior researcher at Mathematica Policy Research.
Medicaid managed care appears to be running more smoothly in states that phased it in gradually.
Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.
Show commenting policy
TribLive commenting policy
You are solely responsible for your comments and by using TribLive.com you agree to our Terms of Service.
We moderate comments. Our goal is to provide substantive commentary for a general readership. By screening submissions, we provide a space where readers can share intelligent and informed commentary that enhances the quality of our news and information.
While most comments will be posted if they are on-topic and not abusive, moderating decisions are subjective. We will make them as carefully and consistently as we can. Because of the volume of reader comments, we cannot review individual moderation decisions with readers.
We value thoughtful comments representing a range of views that make their point quickly and politely. We make an effort to protect discussions from repeated comments either by the same reader or different readers.
We follow the same standards for taste as the daily newspaper. A few things we won't tolerate: personal attacks, obscenity, vulgarity, profanity (including expletives and letters followed by dashes), commercial promotion, impersonations, incoherence, proselytizing and SHOUTING. Don't include URLs to Web sites.
We do not edit comments. They are either approved or deleted. We reserve the right to edit a comment that is quoted or excerpted in an article. In this case, we may fix spelling and punctuation.
We welcome strong opinions and criticism of our work, but we don't want comments to become bogged down with discussions of our policies and we will moderate accordingly.
We appreciate it when readers and people quoted in articles or blog posts point out errors of fact or emphasis and will investigate all assertions. But these suggestions should be sent via e-mail. To avoid distracting other readers, we won't publish comments that suggest a correction. Instead, corrections will be made in a blog post or in an article.
- Man caught jumping White House fence
- If nurses in safety gear got Ebola ...
- 1st Ebola victim in U.S. remembered
- Ferguson slaying of Brown reconstructed in county autopsy
- Coast Guard to seek billions to protect Arctic interests
- Revised Ebola guidelines stress full gear, training
- Navajo to get $554 million in settlement with U.S.
- 4 private security guards convicted
- Immigration work permits could rise under contract
- Coburn’s final ‘Wastebook’ tallies $25B in what he considers ‘pork’
- Personal use of Secret Service agents on staffer’s behalf draws investigaton