Turner, who was fired from Passport Health Plan after she was linked to excessive travel expenses and is now a health-policy consultant, said Kentucky rushed into managed care too quickly — rather than a few months, the state really needed a year, she said. In Turner's view, there also isn't enough expertise in the Cabinet for Health and Family Services to deal with the three new managed-care operators. "I think the managed-care companies really don't have the resources that they need at the state level to give them direction," she said. "On the state side, you have people looking at managed-care processes that they really aren't familiar with."
In other states that switched to managed care, Turner said there was a turnover in state staffing. In Kentucky, "There haven't been cuts, there haven't been layoffs . . . so what are the people who are there at Medicaid focused on, and is there adequate training?"
On Nov. 1, 560,000 Medicaid recipients were switched to managed care, which is "essentially outsourcing" to the managed-care operators, Turner said. Lawmakers have heard complaints about delayed payments and rigid pre-authorization requirements, including one instance Alessi mentioned, involving a woman in labor who was required to get pre-authorization before she could deliver her baby.
Turner said the MCOs are "excluded from the majority of the rules that apply to HMOs," including one that would prevent them from "sitting on" payments." Turner called the process a "bloodbath" for independent pharmacists because of those delayed payments, as well as community mental health centers, who were "seeking pre-authorization . . . but the managed care companies said, 'You can't send it to us electronically.' They were literally snail-mailing these things." (Read more)