If there is one thing that last week’s Medicaid debacle between Appalachian Regional Healthcare and a managed care company illustrates, it’s that when it comes to health care, there are no easy answers. But it also showed an unwillingness on the behalf of some officials to admit that there exists a problem with managed care, and then address it.

In 2011 Kentucky was faced with a hole in the Medicaid budget. Gov. Steve Beshear opted to plug that hole by moving money from the 2012 budget forward to 2011, and then achieve savings in 2012 with a managed care model that he claimed would balance the budget this year.

Managed care, Beshear told a crowd at the Perry County airport in March 2011, “will generate enough savings in the second year to more than overcome the money that we’ll be moving from the second year to the first year. So we can solve this problem by using Medicaid money to balance the Medicaid budget.”

Fast forward to May 2012, and one managed care company, Coventry Cares, has threatened to drop its contract with Eastern Kentucky’s largest health care provider in ARH because in part, Coventry Claims, covering Medicaid patients in Eastern Kentucky is too expensive.

That leads to what we had here last week, which was a panic that several Medicaid patients would lose coverage at ARH and be forced to go elsewhere for care. But dropping the contract would not have solved the problem for either parties. Coventry would still need to cover those patients somewhere, and ARH would still lose business.

Frankly, despite state officials claiming that managed care still works, Gov. Beshear’s plan to save money has backfired for a number of people in Eastern Kentucky who rely on ARH for health care. Though a temporary truce between ARH and Coventry exists, there also exists the possibility that the two companies will not come to an agreement that will keep Coventry’s members in the ARH system. That means those patients, if they want to remain with ARH, would have to sign up for service with another managed care provider. That is a poor option for these folks.

Though we’re not quite ready to write off managed care just yet, because it seems to be working in other states, for Kentucky, when there are agencies like the Perry County Ambulance Authority and the Kentucky River District Health Department that are not getting reimbursed as they should, and ARH which last week stood to lose hundreds of patients, there is a severe need to at the very least make a fix in the system. That starts at the state level.

So far the state, and especially Gov. Beshear, has been oddly absent from that debate.

— The Hazard Herald