Board of Health members also felt the Health Department was better equipped to oversee care of students with chronic medical conditions like diabetes and epilepsy.
Now, however, the MCOs are balking at paying for such services. According to the Courier-Journal, Kentucky Spirit filed suit in October, claiming the managed care system was unsustainable for the Medicaid program in Kentucky. Since the managed care organizations took over Medicaid operations, the Health Department has not received any reimbursement from Kentucky Spirit. As of Oct. 31, the company had been billed $75,892.
Lockard told Board of Heatlh members Thursday Kentucky Spirit claims they were unaware school services were covered under Medicaid, and is unwilling to pay. Coventry Cares also is disputing claims, challenging the entire Medicaid preventive health care package, Lockard said. Coventry has been billed $78,743 by the Health Department, with $27,559 being collected.
The new system also prevents the Health Department from billing Medicaid for services provided to children with private insurance. Previously, all children seen by a school nurse were paid by Medicaid. The Health Department cannot bill private insurers for services provided by a nurse, only services provided by more highly-skilled practitioners, including doctors and physicians assistants.
The lack of payment is causing problems at health departments across the state, Lockard said, with many having to cut employee hours and institute mandatory furlough days.
Increased revenue from the Home Health and HANDSÂ¿programs has allowed the Clark Health Department to stay afloat financially, but Lockard warned it will not be sustainable long term.
The Health Department also has cut about $238,000 in expenses since October 2011.
“As an organization, we’re OK right now, but we will not stay that way,” Lockard said.
The lawsuit between the state and Kentucky Spirit is expected to last two to three years, Lockard said, and health departments are not likely to receive any payments during that time.
Lockard met with school officials earlier this week to discuss the situation, but a plan will not be finalized until the Nov. 13 meeting of the Board of Education meeting. Board of Health members all expressed a desire to continue overseeing the school nursing program, if a financially viable partnership could be reached with the school system.
“If there is a way to make it budget neutral, I’m in favor of continuing the program,” Dr. Brian Andreas, board chairman, said.
Currently, the Health Department employs six school nurses. If a compromise cannot be arranged with the school board next week, the nurses will be laid off effective Dec. 19. The school board would have the option of rehiring all six nurses and employees of the school system. The school system is not required to maintain six nurses, and has the option of replacing some of the nurses with medical assistants, Lockard said.
The Health Department already has been forced to cut the number of nurses working in the schools, down from nine in previous years.
“Ultimately, we wanted to make sure the children were served,” Lockard said. “We’re committed to the well-being of the children.”
According to the Courier-Journal, patients covered by Kentucky Spirit will be moved to Coventry Cares or Wellcare and should not see a disruption in service while the lawsuit is ongoing.
All three organizations are private, profit-generating companies.
Statewide, Kentucky Spirit has been billed $11 million, and paid about $6 million, Lockard said.
“They’ve taken away all the things that made it (the partnership) advantageous,” Lockard said.
Contact Rachel Gilliam at email@example.com.