Kentucky Awards New Contracts for Five Managed Care Organizations
Wednesday, November 27, 2019 10:40 AM
The Cabinet for Health and Family Services Released the following statement this morning.
Following a request for proposal (RFP) process and a state procurement
procedure through the Finance and Administration Cabinet, the Department
for Medicaid Services (DMS) within the Cabinet for Health and Family
Services (CHFS) has been notified of five new statewide contract awards for
managed care organizations (MCOs). Aetna Better Health of Kentucky, Humana
Health Plan, Inc., Molina Healthcare of Kentucky, UnitedHealthcare DBA
UnitedHealthcare Community Plan of Kentucky and WellCare Health Insurance
of Kentucky have been selected to serve Kentucky’s approximately 1.3
million Medicaid beneficiaries beginning July 1, 2020, when the current
New with this procurement, one MCO, WellCare, has been awarded the contract
to serve all children in Kentucky’s foster care system, including some
children who have been adopted from foster care, as well as children dually
committed to the Department of Juvenile Justice (DJJ) system, benefitting
approximately 24,000 enrollees. This Medicaid program will be referred to
as SKY - Supporting Kentucky Youth.
“SKY will simplify day-to-day interactions with providers, allow for more
direct support for staff within the Department for Community Based Services
(DCBS), enhance coordinated access to care for children, and most
importantly improve health outcomes for our youth in out-of-home care,”
said CHFS Secretary Adam Meier.
“Kentucky has made great strides to address these needs and has become a
national leader in finding solutions to better serve the foster care
population, as demonstrated by our early implementation of the Family First
Prevention Services Act (FFPSA) and ongoing Child Welfare Transformation
(CWT) initiative,” he continued.
Choosing one MCO to serve all children in foster care will create a unified
approach to physical and mental health needs utilizing evidence-based
practices and trauma-informed care. SKY will build and sustain access to
appropriate services and supports that have been shown to effectively treat
trauma and conditions that impact a child’s ability to thrive and live a
healthy life. Further, the change to a single MCO will include training for
those who work with Kentucky’s most vulnerable children.
Further, in collaboration with DMS, having one MCO will allow DCBS to
better monitor performance, working toward promoting positive physical and
mental health outcomes, shortening length of time to permanency and
promoting the well being of children.
Over the last three years, CHFS and DMS have met with legislators,
providers, payers and other stakeholders to gain feedback on the content of
the next generation of MCO contracts. As a result, the new MCO contracts
include improvements to performance measures, increase focus on quality
care, implement a new population health management program, place an
emphasis on social determinants of health, require more transparency for
state agencies into all MCO operations and require a centralized
credentialing process for providers.
The new contracts also make several improvements to the management of
pharmacy benefits, including a prohibition on spread pricing for pharmacy
benefit managers (PBMs) and protections in contracting for pharmacists in
The changes also strengthen MCO staffing requirements, adding conditions
for Kentucky-specific experience and education requirements. The new
contracts also expand penalties for non-compliance and establish a
statewide behavioral health line.
“The contracts awarded in the most recent bid process fortify the
department’s ability to oversee the activities of the MCOs and their
subcontractors, significantly improve our pharmacy program and provide a
better focus on critical health issues facing the people of the
Commonwealth,” said DMS Commissioner Carol Steckel. “Together with our MCO
partners, we can work toward improved accountability for and success in
having healthier Kentuckians.”
Changes for Medicaid enrollees will go into effect July 1, 2020. New MCOs
will begin staffing for customer service and building health care provider
network capacity immediately in order to be ready for July 1, 2020,
Medicaid beneficiaries who have questions should call member services at
1-800-635-2570. Anyone who wants to learn more about SKY can email KentuckySky@ky.gov.