As state lawmakers tackle the enormous cost of Medicaid, one rural Republican is calling to cut for profit companies out of the program.

Those are the five insurance companies or managed care organizations that provide health plans and process claims for each Medicaid recipient that you see on your screen.

When we started the managed care experiment back in 2010, our Medicaid budget was $5.9 billion.

Rolling forward and now it's $21 billion.

We've seen a 50% increase in number of Medicaid recipients in the same time, we've seen a 400% increase in the cost.

Unfortunately, that cost is not translated to fair and equitable payments to health care providers, especially in rural areas.

And I probably have been the harshest critic of the managed care model.

And it's probably a little bit unfair to those folks because they're doing their job, which is to increase stockholder equity because they're all for profit insurance companies.

But unfortunately, that's counterintuitive to what we're trying to accomplish, which is maximizing the return on our Medicaid dollars.

We have to change it.

State Senator Stephen Meredith plans to file legislation to conduct a feasibility study for alternative models, including the creation of a nonprofit mutual insurance company.

MacOS came up earlier this year after State Auditor Allison Ball found the state spent $100 million paying for Medicaid recipients who no longer lived in the state.

MacOS benefited from this mishap, as they receive payments monthly for each recipient, regardless of their claims.

The federal changes to Medicaid this year have left health care professionals with a lot of questions and concerns.

This week at the Kentucky Voices for Health Summit, they discussed those concerns with legislators and shared what health policies they want to see prioritized at the state level.

Our Makenzie Spink tells us what health care issues might be brought to the table during the 2026 legislative session.

Fully funding Medicaid is at the top of Kentucky Voices for Health's list of legislative priorities.

The nonprofit says the state should use its Budget Reserve Trust Fund, also known as the Rainy Day Fund, to offset the federal cuts Medicaid is facing.

Representative Ken Fleming is co-chair of the Medicaid Oversight Advisory Board.

He believes the cost of Medicaid is the biggest problem facing the state.

But doesn't believe using money from the rainy day fund is the solution.

The number one issue, at least in my mind, but I'm working on a forecast for two months, is Medicaid.

And Medicaid has gone from this, our $10 billion 5000 years ago to $20 billion this past year cycle.

Now, looking at that is my understanding from the administration to actually $4 billion.

So this is nothing to sneeze at.

Another priority for Kentucky Voices for health increasing access to oral health in the state.

We feel strongly that it's one of the many professional deserts, where we can have a true impact if we were to tweak ever so slightly and allow public health dental hygienists to practice at more locations.

This is a subject Republican floor leader, Senator Max wise knows very well.

His wife is a pediatric dentist.

He agrees that oral health should be a priority in the state.

The other day, she had a family come from talking to Christian County because there was no other Medicaid provider in Bowling Green or waiting camels on the phone.

That's a six hour round trip.

This for someone to come in, can also go for hobbies, too.

She's not turning 81 work, and she sees Medicaid.

But I'll tell you, we're getting to the point, especially with the pediatric readiness.

And that profession that I'm afraid we're going to be seeing, many of them just say.

Whereas Kentucky Voices for health is also pushing for a full time nurse in every school.

According to K v H.

40% of schools in the state have only a part time nurse or no nurse at all.

School health is top of mind.

This is an opportunity where, in the vacuum of air one budget cuts where we could really have an impact.

That doesn't offset the state's budget.

This is an issue Democrat Representative Mary Lou Marcian has been working on for 30 years.

She says she's working across the aisle with Representative Nancy Tate and Senator Stephen Merideth to file a school nurse bill this session.

I do not allow students to hang sheets or get sick and keep them in school.

But, you know, first practitioners also, they can write their prescription or call.

And so the times she stays in school, mom or dad, it doesn't matter who they are or we.

Labor Representative Marcy and says she believes the school nurse Bill, will not have a fiscal impact on the state.

For Kentucky edition, I'm McKenzie Spink.

Thank you.

McKenzie.

The next legislative session begins in less than four weeks on January the 6th.