Three months and one week into KanCare, Kansans can be cautiously hopeful that the massive Medicaid overhaul eventually will realize state leaders’ goals without compromising people’s health. But it’s hard to believe that the Brownback administration, with the tacit approval of the Legislature, still intends to let the program take over long-term care for individuals with intellectual and developmental disabilities next year.
Where is the support to forge ahead? It isn’t within the I/DD community, which argues that long-term services such as community employment, targeted case management and residential assistance don’t fit the medical-services model of KanCare and that the three insurance companies now running KanCare lack the experience to serve that vulnerable population. Advocates and providers also doubt the estimate that excluding I/DD long-term services from KanCare would cost the state $100 million over four years. (The administration says the savings will come from better care and outcomes.)
It only fueled distrust when state senators recently flirted with a bill to bar community developmental disability organizations (CDDOs) from providing both case management and I/DD services. The bill has been set aside for now. But advocates and relatives are right to see it as breaking the administration’s promise that individuals could keep their case managers under KanCare.
The I/DD community also has experienced the turbulence of the KanCare transformation in medical care.
The anecdotes across KanCare have been disheartening, including hassles over primary care assignments, prescription drugs and newly required preapprovals. Slow payments to some providers have resulted in cash-flow problems. The provider network also has been spotty, especially in rural areas and for specialty and dental care.
In some cases, advocates say, the managed-care organizations have refused to talk to case managers for individuals whose disabilities make communication challenging or impossible. All the changes have caused stress for people whose health is fragile.
“It came. It’s here. It’s a problem. And people are feeling it,” Colin McKenney, CEO of Starkey Inc. in Wichita, recently told The Eagle editorial board.
The entire reform is here to stay, though, serving 380,000 low-income and disabled Kansans. KanCare has added some dental benefits, heart transplants and obesity care, and still aims to save $1 billion over the next five years without cutting rates or services.
To their credit, state officials seem committed to working through the transitional issues. They hold regular phone conferences with providers to hear concerns, and an ombudsman helps with troubleshooting. Meanwhile, lawmakers have worked this session to create a KanCare legislative oversight committee.
Asked by the editorial board recently why it was a necessity to add the long-term care of the I/DD population to KanCare, Lt. Gov. Jeff Colyer said, “Because we want to get better results and better outcomes for them.”
For the good of the state’s budget as well as its health, KanCare needs to succeed. But with the administration unwilling to carve out the long-term care of individuals with intellectual and developmental disabilities, the Legislature should act.