Though negotiations between Appalachian Regional Healthcare and Coventry Cares appear to be futile, the state is taking steps to make sure there won't be an interruption in care for the Medicaid recipients who will be affected by the impasse. "The cabinet will assure the judge that, in the event that a notice is received from Coventry that ARH will not be in their network as of July 1, members will be able to call the Department for Medicaid Services to switch" to another managed-care organization, said Jill Midkiff, spokeswoman for the Cabinet for Health and Family Services.
Coventry Cares is one of four companies chosen by the state to provide care to Medicaid recipients. The move to managed care — intended to save money — has been rocky, with providers complaining about delayed payments from the companies and cumbersome pre-approval processes for treatments. ARH sued Coventry, and another managed-care company, saying they owned the hospital chain more than $18 million for services. But Coventry says the state allowed another managed care company not to include ARH in its network, which means a lot of higher-risk, higher-cost patients covered by Coventry.
ARH operates eight hospitals and health clinics in Eastern Kentucky and serves 25,000 Medicaid patients, reports Valarie Honeycutt Spears for the Lexington Herald-Leader. Coventry agreed to extend its contract with ARH until June 30, but will likely not extend it again. A Coventry document filed in court last week says "it appears unlikely that these differences can be bridged." (Read more)