Jacque Clifton: KanCare case managers have conflict of interest

10/07/2012 12:00 AM

10/05/2012 5:17 PM

Gov. Sam Brownback’s KanCare reform is allowing private insurance companies to provide case management for the individuals they will serve in January. This is a conflict of interest – an issue the governor says is currently a problem in Medicaid services.

Under KanCare, the state will pay three insurance companies a flat rate to provide all services for their members. The incentive is real to limit the cost of care so the insurance companies can keep more of the state’s money.

My son turns 18 right as we learn which insurance company will be in charge of his health and disability needs. He is one of the 550 kids on the medically fragile waiver in Kansas, and has been since birth.

The case managers on his waiver have specialized experience with intensive-care kids. They know the services our kids need to keep them at home and out of the hospital.

Yet these independent nurse case managers recently received their pink slips from the state. So now, with less than three months to go before the start of KanCare, I have no idea who will be assessing my son for his services. Will he be lumped in with the aging and disability resource centers that are now just receiving their contracts with the state and whose specialty is elder care?

I have no idea who will be writing and approving his plan of care. Will it be a nonmedical case manager with limited knowledge of his health and medical needs and of the resources available in our community?

And I am very worried that my son’s new KanCare plan will look woefully different from how his care plan looks now. Maybe it won’t change right at first, but I have no doubt that the managed-care company will reduce, refine and eliminate many of the services he receives now.

I’m very concerned for the future of my son and for the future of Kansans with disabilities (young and old) who depend on these services to stay in their homes and communities.

We should all be concerned, as the KanCare insurance companies will be receiving, and possibly keeping, our tax dollars.

Kansans deserve more answers and more time to make sure these companies don’t destroy the safety nets in place for our loved ones.

The governor should rethink his plan to have the managed-care companies provide case management to those they are paid to serve. Otherwise, he is just moving the conflict he says must end to companies with much deeper pockets and a real vested interest to cut costs for their shareholders’ gain.

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