David P. Rundle: Feds must reject KanCare waiver

09/02/2012 12:00 AM

08/31/2012 6:00 PM

Robert Moser, secretary of the Kansas Department of Health and Environment, recently told the Topeka Capital-Journal the public was eager to see the state implement KanCare – the plan that would let Medicaid be managed by three for-profit insurance companies.

That, to put it exceedingly mildly, is a most interesting observation by the secretary. I don’t know how he reached it.

In late August, the Centers for Medicare and Medicaid Services (CMS), the federal agency that must approve Gov. Sam Brownback’s overhaul of Medicaid, set up a page for public comments about the KanCare waiver request. As of Friday, none of the comments was positive.

State officials also conducted several public forums this summer about KanCare. At the one I attended, no one from the audience spoke in favor of KanCare. Based on what I’ve read, that was true at every hearing.

There are sound reasons for this. We know very little of how KanCare would work. The few details we do know are disturbing.

The long-term care for the developmentally disabled would initially be spared from these changes. Thanks to actions by the Legislature this past session, they wouldn’t be covered by KanCare until Jan. 1, 2014.

But those on other Medicaid waivers – such as the physically disabled waiver, which I’m on – would be covered a year earlier if it gets the green light.

It shouldn’t, for several reasons.

For one thing, the nature and function of waiver case managers would change. Now, consumers choose their own case managers, either through an agency such as an independent living center or a private contractor. I have the latter. My manager does an annual assessment of my abilities and needs, writes my plan of care, and serves as an advocate for me with the Kansas Department for Aging and Disability Services.

With KanCare, case managers would be employees of the three companies running the program, the Capital-Journal reported.

“Our services won’t change,” KDADS and KDHE keep saying. But having case managers work on behalf of the insurance companies means that consumers won’t have true advocates. That’s a major change.

Then there are the changes we wouldn’t know about until perhaps Jan. 1, a date the state seems to think is written in stone.

January may have seemed more realistic back in April, when Kansas filed its original waiver request with CMS. But it had to withdraw and resubmit it after it was discovered the state hadn’t consulted two Native American health clinics. Once that was done, the request was resubmitted in July.

As I said, CMS opened a public comment period in late August. It will last a month. Then CMS has a minimum of 15 days to approve, modify or reject the request. Even if CMS were to approve it after only two weeks, everyone involved with KanCare would have only about 10 weeks to prepare for major changes.

Yet Brownback and his administration keep promising a smooth transition. This makes no sense. Nothing about KanCare makes sense. CMS has only one option regarding it.

CMS must reject KanCare.

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