FRANKFORT — When Audrey Haynes sat down before the legislature’s Medicaid Oversight and Advisory Committee Wednesday, she expected the data she brought would persuade lawmakers that Kentucky’s expansion of Medicaid has been good for the state.
The Secretary of the Cabinet for Health and Family Services which administers the Medicaid program also may have expected her statistics to ease unhappiness with the state’s move to managed care for most Medicaid services.
It didn’t happen.
At least she didn’t persuade Republican members who openly questioned the validity of the cabinet’s data, a couple stopping just short of saying the cabinet is making up the numbers.
Rep. Richard Benvenuti, R-Lexington, and committee co-chair Sen. Ralph Alvarado, R-Winchester, who is a practicing physician, balked when asked if they thought the cabinet manufactured the data which showed the programs are either paying for themselves or coming in at less than budgeted costs.
“The numbers do not appear to represent the reality on the ground,” Benvenuti said after the meeting.
“I don’t know who’s providing the data,” said Alvarado, saying he has letters from providers disputing the cabinet’s contention that Managed Care Organizations are paying claims on time in 99 percent of cases.
“Their statistics about what percent of the claims are being paid — I think those are false,” Alvarado said. “I don’t know if they’re lying but somebody is providing bad information.”
The displeasure of the two Republican senators isn’t unique; most Republicans and some Democrats in the legislature complain frequently about the treatment of medical providers by the MCOs. Rep. David Watkins, D-Henderson, a retired physician and father of two practicing doctors, also said managed care payments are often inadequate.
Haynes offered a solution. She pointed out the state moved to managed care because lawmakers complained about the steady increases in Medicaid costs and demanded action to slow those increases. And managed care has saved the state $1.3 billion dollars, Haynes said.
But those who complained about Medicaid costs are now unhappy that medical providers in their districts complain that they receive too little money for their services.
“If you, this august body, would like us to raise the rates, we’d be delighted,” Haynes told the committee. “But you must give us more money to do that.”
Republicans in both chambers are also in almost total agreement Kentucky can’t afford the Medicaid expansion allowed under the federal Affordable Care Act.
For patients enrolled in the traditional, pre-ACA Medicaid system — the aged, blind, disabled and poor children — Kentucky pays 30 percent of the cost and the federal government 70 percent.
Under the ACA, coverage for the first time was extended to those making up to 138 percent of the federal poverty line. Through next year, the federal government pays 100 percent of the cost of the expanded services. Kentucky pays nothing.
Then in fiscal year 2017, the state begins to pick up small increments of the cost until in 2021 the state will pay a maximum of 10 percent while the federal government continues to pay 90 percent.
Currently, Haynes said, Kentucky has added 375,175 people to the expanded Medicaid program — with the federal government so far paying all the costs. And the number of enrollees has shown a slight decline, presumably because of the improving employment rate.
But Alvarado said by 2021 the state will be on the hook for roughly $300 million because of the expansion, based on current numbers and he said the state can’t afford that.
Haynes said multiple independent studies of the Kentucky expansion have indicated the state will actually save money through 2021 at which time the program will begin to cost the state about $45 million extra.
That’s because, she said, expenses for medical services for inmates and state wards previously picked up entirely by the state now qualify for the expanded Medicaid coverage and reimbursement. She said the net savings to the state from 2014 to 2021 is $919 million, “far more than the extra costs.”
Haynes also pointed out that the expanded Medicaid has increased payments to Kentucky medical providers — doctors, hospitals, pharmacies and others — by $2 billion through March of this year.
Alvarado, Benvenuti and other Republicans didn’t appear convinced, however.
Ronnie Ellis writes for CNHI News Service and is based in Frankfort. Reach him at firstname.lastname@example.org. Follow him on Twitter @cnhifrankfort.