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Kentucky Medicaid Managed Care

Managed Care Update

Beginning Jan. 1, 2013, four MCOs have also been awarded contracts to provide coverage for the 175,000 Medicaid recipients in Louisville and 15 surrounding counties, also known as Region 3. Those MCOs are:

Information for Medicaid Providers

The state has established three contracts with managed care organizations (MCOs) to provide services to Medicaid members across Kentucky. Three of those contracts are with new vendors that will serve more than 560,000 recipients beginning Nov. 1, 2011.

Enrollment of Medicaid members into the new MCOs will begin in August. Each new MCO is establishing a network of health care providers to provide medically necessary services to members. Existing providers of Medicaid services may be contacted by one or more of the new MCOs about providing Medicaid services under the new plans. Medicaid encourages providers to participate in all MCO provider networks.

The current statewide MCOs are:

CoventryCares of Kentucky – a Medicaid product of Coventry Health and Life Insurance Company. Coventry Health and Life Insurance Company is a subsidiary of Coventry Health Care, Inc. Coventry companies currently offer Medicaid managed care services in eight states: Florida, Maryland, Michigan, Missouri, Nebraska, Pennsylvania, Virginia and West Virginia.

WellCare of Kentucky – a part of WellCare Health Insurance of Illinois, which currently serves 2.2 million members in seven states: Florida, Georgia, Hawaii, Illinois, Mississippi, New York and Ohio

Contact information for each MCO can be found here or visit the Medicaid website for additional provider information. Download a letter to providers about the coming Nov. 1 implementation (Oct. 25).

Providers may also download: a letter and frequently asked questions document sent to providers (July 22), a question and answer document sent to hospitals (Aug. 5), a follow-up letter and updated frequently asked questions document sent to providers (Aug. 12), Managed Care Policy for Out-Of-Network Providers (Nov. 8), Managed Care Policy for Out-Of-Network Dental Services(Nov. 18). Or read a news release about the one-month extension of implementation to Nov. 1 (announced Sept. 19).

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