Kathy is worried – so much so that I’m not using her real name.
The 63-year-old social worker provides services for people with disabilities. She is worried about the scheme by Gov. Sam Brownback and Lt. Gov. Jeff Colyer to turn all Medicaid waivers into managed-care systems. But Kathy’s concerns go far beyond her clients.
Kathy is a mother of a child with both a mental disability and a mental illness. Kathy had her son when she was 25. When he was screened at kindergarten, it was determined he had what was then called mental retardation. At 19, he was diagnosed with schizophrenia. Kathy has no other children, and her son’s father died some years ago.
Kathy works in Wichita but doesn’t live here. Her son does. He has had a case manager and a worker who comes once a week to help with his apartment and a nurse who sets up his medications.
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Kathy likes her son’s case manager and support system, but Medicaid in Kansas is about to undergo a radical change – not to improve the quality of the care vulnerable Kansans need but simply to hold down costs.
Let me be clear: I am not opposed to holding down costs. Nobody is. But I have been told that is all Brownback and Colyer are focused on. I have communicated with two other people with family members with disabilities who are greatly concerned with the direction the administration wants to take Medicaid.
One person told me that Colyer wants to change the focus of Medicaid into “medical model.” In other words, people with disabilities will be seen primarily as patients to be cured. Colyer also wants to encourage people with disabilities to work. That’s fine if a person can work full time, but many of us cannot. That’s just the reality.
Another problematic wrinkle in the new plan prohibits someone who works at, say, Starkey Inc. from having a case manager who also works there. Brownback and Colyer view this as a conflict of interest. However, the relatives who gave me their input say these case managers tend to know best what the individuals need.
No matter. Under the new plan, people will be randomly – I said randomly – assigned to one of three for-profit companies, all located out of state. So someone like Kathy’s son may end up phoning a case manager and having to select from a phone menu.
“He can’t do that,” Kathy told me.
Kathy reminded me of her situation. “I’m not young anymore. I could have a stroke. I could get Alzheimer’s. I won’t be here forever.”
Containing costs and providing humane care to the most vulnerable are not mutually exclusive. The current system could be tweaked to lower expenses, but radical experiments with no heart will fail. Mothers like Kathy will fight them. I’d bet on people like Kathy to win.