Haynes: Medicaid case managers threatened, and more bumps ahead, but state beginning to see advantages of new system

By Al Cross
Kentucky Health News

Some Medicaid case managers' lives have been threatened because they have tried to get Medicaid patients to go to primary-care doctors instead of emergency rooms, Health and Family Services Secretary Audrey Haynes said today.

Haynes, right, and two key legislators talked about managed care, the possible expansion of Medicaid under federal health-care reform, and the insurance exchange being set up under the law, at the Kentucky Chamber of Commerce's annual policy conference in Lexington.

The case managers work for insurance companies that oversee Medicaid under contracts with the state. Haynes said the cases of threats have been reported to police.

One key to making managed care work is more prevention, Haynes said, but "People want to go to the emergency room." She mentioned one case of a Medicaid recipient who had gone to emergency rooms 57 times in 30 days.  Under federal law, hospital emergency rooms generally cannot refuse to treat patients who present themselves.

"They will abuse the emergency room because that is the system they know," said Republican Sen. Tom Buford of Nicholasville, chairman of the Senate Banking and Insurance Committee.

Haynes said, "Our people are getting sicker, especially folks on Medicaid, and we can't allow people to use high-intensity . . . high-cost services."

Haynes, an appointee of Democratic Gov. Steve Beshear, and her cabinet have come under fire for not putting more pressure on managed-care companies to make timely payments to hospitals, doctors and other providers. She was not asked about that, but alluded to it: "There have been lots of bumps in the road, and some of them may continue."

But she said the state is only beginning to see what can be gained from the new system, which is supposed to save hundreds of millions of dollars. "We were one of the last states to look at managed care," she noted.

Buford said "I don't disagree with anything she has said," but said the Beshear administration rushed into managed care. "I don't think there's much we can do. We are in this lady's hands on this issue and we'd better support her."

Buford predicted that Beshear would try to expand the Medicaid program to households earning up to 138 percent of the poverty level, a key part of the federal reforms but one the Supreme Court said must be optional for states, not mandatory.

"It will be difficult for him to say no to the expansion of the Medicaid rolls," which the federal government would entirely cover in the first two years, Buford said. That would be reduced to 90 percent by 2020, but Buford predicted that the federal government will ask the states ot accept less because it won't have the money.

Haynes said Beshear would like to expand Medicaid, and a "deep-dive economic analysis" is being done now, with the help of the federal Department for Health and Human Services, to establish the financial parameters. "We probably won't know for several months because we're still getting a lot of guidance from HHS," she said.

Haynes said expanding Medcaid would bring $10 billion to $12 billion to the state, having a significant economic impact, and the managed-care companies came to the state expecting the expansion.

She said HHS is calling the state's effort to set up the insurance exchange, a marketplace for health coverage, a model for other states.

However, Buford said the Senate, which has 24 Republicans and 14 Democrats, in a state that voted against President Obama by a similar margin, will probably allow Beshear to re-issue the excutive order creating the exchange rather than adopting it into law. "That would be impossible to make it through the state Senate in the next two years," he said.

Buford said he favors a federal exchange as "the best bang for your buck on premium costs," but said the state is too far into its own exchange to do that now. However, when the grant funds being used to create it run out, "I don't know what this exchange will be," he said, indicating that the legislature would not authorize the fees on insurance companies that the exchange plans to levy to finance its operations.

Buford made many criticisms of the reform law, but Rep. Susan Westrom, chair of the House Health and Welfare Committee, asked, "If this is such a horrible thing," how would it be passed by Congress and "upheld by the Supreme Court?"

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