Manage Delivery
When Aldona Carney recently tried to fill a prescription for her son who is on Medicaid, the coverage was denied.
“They denied a generic antibiotic for a sinus infection because it was a liquid and it wasn’t ‘age appropriate,’ ” said Carney, whose son Neil has severe autism and recently turned 18.
He can’t swallow pills, she said.
“Change to people in general is hard. When you’re trying to change something for a person with developmental disabilities, it can cause major problems,” Carney said.
Since the state’s new privatized Medicaid program — KanCare — launched on Jan. 1, there have been reports of some hiccups in the new program, which are slowly being resolved.
Now, three managed care organizations — Amerigroup, United Healthcare and Sunflower State Health Plan, a subsidiary of Centene — share responsibility for the state’s roughly 370,000 KanCare recipients.
By privatizing the administrative side, Gov. Sam Brownback says the state could save more than $1 billion over the next five years.
In Carney’s case, her son was able to get the medicine he was prescribed. She e-mailed legislators and Kansas Department of Aging and Disability Services Secretary Shawn Sullivan, and Carney said Sullivan was helpful in getting the issue resolved. She also heard back from her son’s MCO, Sunflower, which said it was looking into the issue.
“With KanCare, my concern is if they look at cost over care,” Carney said. “If you don’t have a good case manager to help you along the way, one that’s in your corner and not worried about cost, you’re just lost.”
A point of contact
In an effort to help consumers and providers with KanCare questions and problems, Lawrence attorney James Bart was appointed the KanCare ombudsman in December.
Overall, he says the transition to the new program is going well. His office has received about 152 contacts from consumers and providers and has an overall 92 percent resolution rate.
The majority of questions have been from consumers, Bart said. Early on, many were unsure of which plan they were enrolled in or whether they were still eligible for services. There were also reports of problems getting prescriptions, Bart said.
Reports of Medicaid recipients being assigned different or inappropriate primary care physicians are still cropping up, he said, due to issues with the transfer of information between the state’s database and the MCOs.
But people who were assigned an inappropriate primary care physician can use their previous physician for 90 days and they will continue to be paid as an in-network provider.
Consumers have until April 4 to switch to another MCO, Bart said.
“While there is still work to do, the implementation of KanCare, especially with the relationship that our staff and the three KanCare companies have built with the consumers and service providers, is progressing well,” said Sherriene Jones-Sontag, Brownback’s press secretary.
Providers’ perspective
Jon Rosell, executive director of the Medical Society of Sedgwick County, said the transition seems to be going well.
“I think KanCare is a substantial systems change for not only patients and health care providers. So far, it appears to be progressing smoothly,” Rosell said. “That’s not to suggest there aren’t specific problems with patients or providers, but in general, the impression I get is it’s going smoother than expected.”
Billing has been the top issue for providers, Bart said. Any out-of-network provider will be reimbursed at 90 percent, he said.
It’s still not completely clear what percentage of providers who previously treated Medicaid patients have been contracted by the three MCOs. The KanCare website provides geo-coded information on it, and individual providers are listed on the site.
“There was a conscious effort to attempt to contract with all previous Medicaid providers,” Bart said. “Some providers waited to see if KanCare would actually take effect on Jan. 1. Once the (Centers for Medicare and Medicaid) granted waivers, at that point, a lot of providers sent in contracts. It takes up to 30 days to contract and up to 30 additional days to credential them. There are a lot of people still in the pipeline.”
Monica Stoneking, marketing and communications director for Sunflower, said in an e-mail that they can’t provide a percentage of providers in the network because it’s changing every day.
Maureen McDonnell, vice president for public affairs and communications for Amerigroup said in an e-mail that “Amerigroup has been on the ground in Kansas building relationships with providers and developing the network for approximately 18 months now. We are very pleased with our current contracted providers and will continue to expand appropriately.”
But she did not provide any numbers for providers or any information on any issues they have had.
A representative from United did not respond to an e-mail.
Disability issues
Dee Staudt, director for the Sedgwick County Developmental Disability Organization, which works with the state and providers, said their case managers and other organizations that work with them have reported several issues with the new system since it took effect.
It’s only a snapshot, Staudt said, since the organization has about 2,000 people in its system are eligible for Medicaid.
“I think it’s fair to say it’s too early to tell either way,” Staudt said. “I don’t want to say I’m Chicken Little and the sky’s falling, but it’s been a little rough ... You can’t really tell the full scope because you’re not necessarily going to hear all of the stories.”
The change has been especially challenging for those who have developmental disabilities, Staudt said.
Charlotte Kelly of Wichita was told that her 42-year-old daughter had been dropped from Medicaid when she took her to the doctor about two weeks ago.
Kelly said she never received the enrollment packet at the end of 2012 and was eventually able to get her daughter, who has developmental disabilities, reinstated in the program. She said she isn’t sure how the bills from the most recent doctor’s visit will be handled.
“Communication was not what it should have been. It was frustrating and caused a lot of anxiety on my part,” Kelly said. “Everything is just wait and see how this works. I’m hoping once we’ve been established and gotten things under way it will be a smother transition than the beginning of it.”
Ruth Peters of Walton has been a guardian for a mentally disabled man for about five years. Recently, she spoke with the man’s assigned MCO, Sunflower, at length about his medical history and other information.
But a week later, another representative called and said they couldn’t accept information from her because they didn’t have a form signed from the man saying she could disclose information.
“He’s severely disabled and can only print a few letters of his name,” she said.
Since then, the issue has been resolved, she said but she hasn’t received any paperwork or interviews for another person for whom she acts as guardian.
“I’m hoping she hasn’t fallen through the cracks,” she said.
