Friday, February 16, 2001

Ky. putting 69,000 patients into HMO

State would save on medical care for disabled

By Tim Bonfield
The Cincinnati Enquirer

        Kentucky plans to require about 69,000 people with disabilities to enroll in KenPAC, the state's Medicaid managed-care plan, starting March 1.

        State officials predict the move will save $10 million to $15 million in two years by improving coordination of care for people with chronic health problems, reducing unnecessary emergency department visits and increasing access to preventive care.

        However, the change also could require some enrollees to switch doctors because fewer than half of Kentucky's primary care doctors participate in KenPAC.

        The change affects adults who receive Supplemental Security Income (SSI) benefits, a federal program that supports people who cannot work because of physical or mental disabilities.

        The 69,000 SSI recipients will be added to more than 250,000 Kentucky residents already in KenPAC, primarily low-income mothers getting welfare assistance.

        But there are several groups not affected by the change, including children on SSI, adult SSI enrollees in nursing homes, hospice or psychiatric facilities and Medicaid enrollees living in the Louisville area who are covered by a different managed-care plan.

        The reform will require SSI recipients to choose from a list of 1,500 primary care doctors, about 41 percent of the 3,640 primary care doctors statewide.

        “We think (the need to switch doctors) is a remote possibility. Our records show that 80 percent of people on SSI saw a KenPAC doctor in the past year,” said Gil Lawson, spokesman for the Kentucky Cabinet for Health Resources.

        “If they have a physician who is not in KenPAC, we will approach that doctor and ask them to join.”

        To entice more doctors to participate, the state has increased a monthly management fee from $3 per month per enrollee to $4. It also will pay a bonus to any doctor who adds 20 KenPAC patients to their practice.

        While doctors see some possible benefits from the change, they also wonder how many more doctors will be willing to see KenPAC patients.

        “Providing more of a medical home for these patients is a good idea. But Medicaid reimbursement is marginal for primary care doctors and unacceptably low for many specialists,” said Dr. William Vonderhaar, president of the Kentucky Medical Association.

        Even as this reform begins, the Kentucky legislature is debating other ways to deal with a Medicaid budget shortfall. The prospect that doctors could take other cuts in Medicaid reimbursement makes this change harder to accept, Dr. Vonderhaar said.

       Enrollment for SSI recipients into KenPAC will occur between March 1 and May 1. Information: (877) 639-0010.


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