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Kentucky Medicaid Managed Care

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Medicaid Managed Care General Information

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  • Selected: Medicaid Managed Care General Information (9)

  1. TOPHow is Kentucky Medicaid changing?

    Kentucky is moving to a managed care model statewide. Kentucky Medicaid has contracted with three new companies to begin coordinating health care for most Medicaid members beginning in November. The new companies, or managed care organizations (MCOs), are: CoventryCares of Kentucky, Kentucky Spirit Health Plan and WellCare of Kentucky.

    Members in Jefferson County and the 15 surrounding counties served by the Passport Health Plan will continue to receive managed care services through that plan. 

  2. TOPWhy is the state switching to a managed care system statewide?

    Switching to a managed care system allows the state to improve the health of Medicaid members while reducing costs.

    The state projects that the new system will save taxpayers $1.3 billion over the course of the new, three-year contracts, and will result in the creation of 543 new jobs in the Commonwealth.

  3. TOPHow does managed care work?

    Medicaid has traditionally operated on a fee-for-service basis. Under the managed care system, the MCO receives a fee for each Medicaid member it serves. This results in better coordination of health care services across multiple health care providers.

    Managed care focuses on improving health outcomes through coordinated care, preventive services and by offering disease management for individuals with chronic conditions like diabetes or asthma. It also focuses on reducing the unnecessary use of services, such as emergency room visits for non-emergencies or duplicate tests.

  4. TOPHow will benefits change?

    There will be no reduction in benefits or covered services.

    The MCOs may also choose to offer additional services.

  5. TOPWill co-pays increase?

    The MCOs cannot charge more than the current Medicaid co-payments.

    MCOs may, however, choose to charge less.

  6. TOPWill this affect all Medicaid members?

    Most Medicaid members will receive coverage through the new system. Those in nursing homes and waiver programs will not.

    Members in Jefferson County and the 15 surrounding counties served by the Passport Health Plan will continue to receive managed care services through that plan.

  7. TOPHow are members being notified about their new MCO?

    The MCOs are establishing provider networks across the state. Medicaid members will initially be assigned to an MCO based on their medical needs or current primary care physician. Members were notified by letter of their MCO assignment in August. The deadline to change MCOs has been extended to Oct. 5. Changes can also be made within 90 days after managed care begins on Nov. 1. After that, members will have an opportunity to switch MCOs annually, similar to private health insurance open enrollment.

    For help with questions about managed care coverage, members can call 1 (855) 446-1245 from 8 a.m. to 6 p.m. Eastern Time, Monday through Friday.

  8. TOPHow can I find out which MCO networks my health care provider has joined?

    Members can search the MCO provider directory to confirm which networks physicians and other health care providers have joined. The directory will be updated weekly as more providers are added to the MCOs' networks. Search for providers by:

  9. TOPWhen will managed care begin?

    Medicaid Managed Care was originally targeted to begin Oct. 1, 2011. That date has been extended by one month, in response to a request from the Kentucky Hospital Association. Managed care coverage will now begin Nov. 1, 2011.
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