UP - Changes in Healthcare Access in KY Medicaid (C5540) FY25

Medicaid managed care (MMC) is widely used to control health care costs. While there are certain aspects of MMC markets that are linked to improved access among Medicaid beneficiaries, beneficiaries still face certain hurdles in health care access if the needed health care is 1) offered by physicians or other health professionals outside the insurers network, or 2) there is uncertainty regarding access to physicians within the ‘stated’ network. Some health care professionals (e.g., physicians) may be listed as accessible to beneficiaries within plans they are contracted with. However, some contracted physicians may see few or no Medicaid enrollees, while a small number of physicians treat a disproportionate share of enrollees. Increasingly, “phantom” or “ghost” networks counter Medicaid’s and even the Cabinet for Health and Family Services (CHFS) mission to ensure access to some of our most vulnerable Kentuckians. The key goal for this study is to develop new knowledge for the Commonwealth of Kentucky regarding accessibility to primary and specialty care within the Medicaid program, across the Commonwealth’s MMC Regions, and between the Medicaid managed care organizations (MCO).