David P. Rundle: Keep I/DD care, oversight out of KanCare

05/10/2013 12:00 AM

05/09/2013 5:22 PM

Aiden (not his real name) is an adult with Down syndrome and some attention deficit. He lives in a group home run by one nonprofit agency in Wichita and participates in a day program run by another.

Receiving KanCare under the intellectually and developmentally disabled waiver, Aiden has had the same case manager from one of these agencies for 10 years. Aiden’s mother, who is also his legal guardian, considers the case manager an important part of the team guiding Aiden’s life and wants to keep her.

However, this may not be possible. Senate Substitute for House Bill 2155 would bar agencies providing other services to people on the I/DD waiver from also providing case management. Instead, the three managed-care organizations overseeing KanCare would provide case management, as they do with people on other waivers. That includes the physically disabled waiver, which I’m on.

Proponents of the proposed law say it is needed to eliminate any conflicts of interests that the current I/DD waiver case managers may have. Opponents, including Aiden’s mother, say there is no conflict and distrust the proposed change.

Aiden’s mother feels she has reasons. Once she spent an hour on the phone being transferred from one managed-care organization employee to another. Why did she call? She wanted to have the MCO send any mail to her, not Aiden.

Another time she was on the phone trying to get an answer to a yes-or-no question on prescriptions. In the end, this very simple question baffled the MCO, and the mom had to call the KanCare ombudsman to get an answer.

I wrote in a previous commentary of similar problems I’ve experienced with an MCO. So despite the fact that the Brownback administration claims KanCare is off to a great start, the evidence I continue to hear and experience tell me otherwise. The bulk of the problems I’ve gathered relate to medical issues, things you would think private health insurers would know about.

Case management for people with intellectual disabilities is just not done by for-profit insurance companies. Parents and guardians know this, which is why they want case management and long-term care carved out of the I/DD waiver permanently.

Who could argue with sound reasoning like that? The MCOs and the administration, that’s who.

Since it was first rolled out, backers of KanCare have said its foes just don’t appreciate how great it is. The problem, they maintain, is not with KanCare but with people’s ignorance and unwarranted fear of it.

At a recent meeting about the I/DD waiver in Olathe, Shawn Sullivan, secretary of the Department for Aging and Disability Services, sought yet again to reassure parents and guardians that their concerns were groundless. Despite the fact that representatives from the MCOs were there to back him up – or maybe because of it – after 90 minutes Sullivan changed few if any minds.

As the Legislature begins its wrap-up session, parents, guardians and InterHab, the statewide group of I/DD service providers, are mounting an all-out push for a permanent carve-out of long-term care services. Supporters of turning the service over to the MCOs may well win the battle in Topeka, but they are not winning Aiden’s mother to their side.

She fears an MCO case manager will be driven by his employer’s bottom line, not by Aiden’s best interests. It is a fear many outside the enlightened world of Gov. Sam Brownback, Sullivan and the MCOs share.

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