Changes to Kentucky Medicaid program may leave patients out of n - wave3.com-Louisville News, Weather & Sports

Changes to Kentucky Medicaid program may leave patients out of network

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Anne Martin Anne Martin
State Senator Julie Denton State Senator Julie Denton

LOUISVILLE, KY (WAVE) - A warning to parents about their children's health care. At the beginning of the year, Kentucky increased the options of Medicaid managed care providers and it could mean some of the biggest hospitals in the city are no longer in network.

If your child is enrolled in Kentucky Children's Health Insurance Program, hospitals including Norton and Kentucky One may now be out of network if you don't call and ask for a change of provider.

In Louisville alone, the Cabinet for Health and Family Services said it applies to 68,000 kids enrolled in KCHIP. In total for Jefferson County and the 16 surrounding counties, it affects 170,000 Medicaid patients.

Anne Martin's son is 17 years old. It doesn't take much to her bragging about her three children. "My youngest who is 17 is a Junior at Male. He just took his SAT and is in the 90th percentile." Martin says getting her son to that point took a lot of help from doctors. "There was no question from the beginning that Jacob was hyper and ADD."

After years of testing out different medications, they finally found one that worked, so you can only imagine how shocked Martin was when, "I received a letter that they were no longer going to cover Jacob's medication."

On disability herself, Martin's son gets insurance through KCHIP. It provides coverage for families who have too much money for Medicaid but not enough for private coverage. Beginning January 1, 2013, Kentucky added four different Managed Care Options, or MCOs, and assigned each patient randomly. At least one of those providers is out of network for doctors with Norton and Kentucky One.

After realizing her son had that MCO, Martin switched. It is an option for anyone in KCHIP. "Right now you don't have to have a reason. They can just call the department and say they want to switch to whatever MCO they want to choose," said Lisa Lee, Deputy Commissioner for the Department for Medicaid Services.

However, there is a deadline. Parents can call between now and March 29 to switch no questions asked. Starting April 1, the MCO will be in place for a year unless there's an unforeseen conflict.

Kentucky Senator Julie Denton co-chairs the Health and Welfare committee and said she is not sure every parent is aware of what has changed, "Even those who do get the letter will they really understand and comprehend the severity and gravity of the situation?"

Lee assures that no one is losing their medical benefits, but Denton and Martin said the changes do affect access, so parents need to do their research or parents may show up for a visit to the doctor without coverage.

The number to call to make a switch is 1-855-446-1245.

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