And Lexington is considered by some to be a wealthy city. Other health departments aren’t that lucky. The Lincoln Trail District has sent nurses into school systems in an attempt to increase revenue through expanded clinical services.
“A lot of us write grants to try to do different programs,” Sims said. “[Clinical] services used to be 53 percent of my revenue, but it’s probably down to about 35 to 40 percent in my area. Revenue will always be changing.”
As long as there is funding for health department nurses to go into schools to offer clinical services such as pediatric insulin monitoring or treating acute asthma symptoms, either through grants or subsidies, the health departments might have a chance. But there is yet another financial seam ripper that could compromise the sustainability of core services — non-payment from newly adopted managed care organizations (MCOs).
Sims said that flagship MCOs were in place in the late ’90s, long before the ACA came to be, but implementation of the current MCOs (Coventry Cares, Wellcare, and Kentucky Spirit) has been rough.
“When you are dealing with something like Medicaid, there’s a vast difference from a system that’s been in place for years and has a great reputation in how they paid and their set up,” Sims explained. “The best-laid plans won’t work overnight when you are doing this kind of mass turnaround.”
Kentucky health departments are feeling the financial pull of the MCO non-payment issues, specifically from Kentucky Spirit Health Plan, which has decided to end its participation in the Medicaid insurance plan a year early.
“To make us solvent, to keep our budget balanced, we cannot bring in less revenue from those places where we should be receiving revenues,” said Drew Beckett, director of the Bourbon County Health Department, who said that since November 2011, his health department has had problems receiving reimbursements from Kentucky Spirit.
The Bourbon County Board of Health, a type of local governing body for the health department, has approved notices published in the Bourbon County Citizen-Advertiser, advising patients they will no longer accept Kentucky Spirit Health Plan coverage.
“We are trying to be as fiscally responsible as we can. We are really not trying to burden our patients or our community any more than we have to,” Beckett said. “This is the reality of the times. We are all trying to take a hard look at the services we provide, and we hope to continue those services that our community needs and that we are mandated to do.”
So in light of reductions, state and federal mandates and lost revenue in the form of MCO non-reimbursement issues, Kentucky health departments are trying to re-examine their focus on their big-picture mission — a complete tapestry of health for all Kentuckians.
“There is not much in [the ACA] about ‘take care of yourself.’ There is a lot about reducing the cost of health care, but the whole business of how do you get the community and individual people to take better care of themselves is rarely tied to health-care reform acts,” Leach said. “An army that is sick doesn’t fight very well. We are better as a society if we aren’t sick, and that’s what we are trying to focus on.”
Leach added that there isn’t much anyone can do with the ACA except “figure out the best way to live with it.” In the meantime, he said, his agency will do what they have done for the past 109 years: protect Lexington.