September 23, 2012

Eagle editorial: KanCare worries persist

As the days count down between now and the Jan. 1 scheduled launch of KanCare, worries persist regarding the transformation of Medicaid into a privatized managed-care system.

As the days count down between now and the Jan. 1 scheduled launch of KanCare, worries persist regarding the transformation of Medicaid into a privatized managed-care system.

Plans call for the more than 350,000 low-income Kansans served by Medicaid to have their care newly coordinated by three private health plans. The Brownback administration has said KanCare will save $1 billion over five years without cutting provider rates, eligibility or services. And the insurers say they’re adding dental services and help with weight loss and smoking cessation.

That’s promising a lot – so much that many wonder how KanCare possibly can deliver it all long term.

First, though, the plan still needs a go-ahead from the Centers for Medicare and Medicaid Services (CMS), which is overseen by the U.S. Department of Health and Human Services and Secretary Kathleen Sebelius. The state’s first application needed a do-over, compressing the implementation and leaving people wondering how the state, companies, providers and patients can be ready by Jan. 1.

Shawn Sullivan, secretary for the Kansas Department for Aging and Disability Services, recently told lawmakers that a decision would be made by Oct. 19 regarding whether KanCare would proceed as scheduled Jan. 1. As it is, the insurers are supposed to have their provider networks assembled by Nov. 16; according to the Kansas Health Institute News Service, preliminary provider manuals just became available late last week.

But as the one-month period for public comment came to an end Friday, the CMS website showed the proposal being roundly panned by Kansans. In dozens of comments, they fretted about the loss of trusted health providers and case managers, the potential for conflicts of interest when case managers are employed by the private insurance contractors, and more.

“Cost shifting and cost containment will lead to cuts in services and the numbers of providers will go straight down,” predicted one Kansan.

“Who will supervise the insurance companies to ensure that things are taken care of and needs are met?” asked another.

Others said: “This has been a heavy-handed, opaque transition.” “They are not prepared and will not be in three months.” And “this is only an experiment, and what happens when the experiment fails?”

There also was much criticism of the plan, deferred until 2014, to include long-term care for individuals with developmental disabilities in KanCare, as well as concern for what KanCare will do to reduce the numbers of Kansans waiting for home- and community-based services.

The Kansas Department of Health and Environment and KDADS will try to clear up some of the confusion this week by holding meetings in 12 cities Monday through Wednesday and a teleconference on Thursday. The meetings in south-central Kansas will be held Wednesday in Hutchinson and El Dorado (1-3 p.m. for providers and 6-8 p.m. for consumers at both sites). For more information, go to www.kancare.ks.gov, or consumers can call 1-866-305-5147 and providers can call 1-800-933-6593.

During the Joint Budget Committee hearing this month, state lawmakers were warned that KanCare’s Jan. 1 launch was susceptible to “go fever,” a NASA expression for when danger signs are ignored in the rush to get off the ground.

“Because so much energy is expended to get to the moment of launch, the temptation to ignore the warning and just go is great. Go fever is never a good thing,” said Matt Fletcher of InterHab, which advocates for Kansans with developmental disabilities.

Should CMS approve its plan soon, the Brownback administration must be wary of such “go fever.” With so many vulnerable Kansans’ lives at stake, and so many lingering questions, the priority should not be speed.

For the editorial board, Rhonda Holman

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