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Friday, April 11, 2014

Worried about KanCare


The Brownback administration’s plan to turn Medicaid into a managed-care system is a promising reform that could save the state money. But the administration’s development and handling of KanCare thus far haven’t inspired confidence.

The latest embarrassing setback was the administration’s withdrawal last week of its waiver application with the federal government. It turns out officials neglected to notify two Native American health centers of the proposed change.

The withdrawal means the administration now must follow new federal transparency rules requiring it to hold at least two public meetings (one of which will be 2 p.m. Monday at Wichita State University’s Hughes Metropolitan Complex, 5015 E. 29th St. North). The administration initially avoided this requirement by submitting the waiver application on April 26, the day before the new rules went into effect.

The administration plans to resubmit the application in July, and it doesn’t think the delay will change its plan to implement the managed-care system by Jan. 1. That assumes the federal Centers for Medicare and Medicaid Services will approve the waiver request – and do so quickly. That’s not a sure thing.

The administration largely developed the plan behind closed doors. When it was unveiled, advocates for Kansas with developmental disabilities were particularly concerned that the long-term care of this population was included in the reform.

For months, the administration dismissed their pleas to carve out such care from the reform. Finally, after state lawmakers moved to block KanCare, the administration announced it would delay implementation of this part of the reform for one year.

Concerns remain about whether the reform will save as much money as the administration claims. Budget projections (and tax-cut plans) assume savings of about $300 million, though it’s unclear how that number was determined.

There also are concerns about the five insurance companies vying for the state contracts. One company, WellCare Health Plans, agreed in April to pay $137.5 million to settle claims that it defrauded Medicaid programs in nine states. Another bidder, Amerigroup, paid $144 million in damages and $190 million in fines in 2008, the Kansas Health Institute News Service reported.

Three of the five KanCare bidders also manage Kentucky’s new Medicaid system, which has been plagued with problems. Kentucky’s state auditor found that between November 2011 and February 2012, the insurance companies took $708 million from taxpayers and paid providers only $420 million, KHI News Service reported.

There also are still questions about how exactly KanCare will work, including the enrollment process.

Despite all the stumbles and bumbles, the Brownback administration acts as if everything is fine and there is no cause for concern – which is another reason to worry that it doesn’t know what it is doing.

For the editorial board, Phillip Brownlee

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