Centene must cover preventive care provided in schools, court says

Centene's Medicaid managed care company operating in Kentucky has been ordered to repay about $8 million to the state for failing to cover preventive care provided by health departments in schools.

A state court ruled Tuesday that Kentucky Spirit, which has one of three contracts to manage the state's Medicaid program, must pay for all preventive care services provided by school nurses because the state's contract requires reimbursements to local health departments, reported the Louisville Courier-Journal.

"Kentucky Spirit is not free to disregard this longstanding interpretation of Medicaid eligibility and unilaterally re-interpret these to the detriment of local health departments," Judge Phillip Shepherd said in the ruling.

That means the state's 59 county health departments will be reimbursed for services that Kentucky Spirit has declined to pay, according to the Associated Press. "Well-child developmental exams, immunizations, school exams--basically any service that we provided at the health department is provided within a school setting," Director of Hopkins County Board of Health Jack Morris said. "And they refused to pay for any service provided outside the main health department."

Kentucky Spirit had refused to cover payments under its contract, saying the services were provided without a health department doctor's supervision. But Shepherd determined the services must be reimbursed, regardless of whether they were provided by nurses in a school or doctors in a public health department clinic, the Lexington Herald-Leader reported.

In response to the ruling, Centene said it's reviewing the order and considering all options, including whether to appeal the decision.

To learn more:
- read the Louisville Courier-Journal article
- see the Lexington Herald-Leader article
- check out the Associated Press article

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