On Jan. 1 of this year, the state of Kansas rolled out KanCare, our Medicaid reform program. The state has contracted with three managed-care organizations to administer KanCare.
Implementation for long-term care of developmentally disabled Kansans was delayed one year at the request of the Community Developmental Disability Organizations, a network of 27 providers from around the state. A pilot program has been established to aid in the transition to KanCare.
Some CDDOs have resisted change from the beginning and have advocated for a “carve-out” of long-term care. However, a study conducted in 2008 by the University of Kansas School of Medicine involving four CDDOs and 955 developmentally disabled clients revealed deficiencies in medical care for chronic disease management and appropriate cancer-screening protocols. Experts including Robert Moser, a primary-care physician and secretary of the Kansas Department of Health and Environment, have stated that better health outcomes will occur when health care, behavioral care and long-term support and services are incorporated under one umbrella of care with one entity, the managed-care organization, accountable for appropriate health outcomes. They state that long-term care cannot be conducted in a vacuum.
Many concerns have been raised regarding DD services under KanCare, including that:• People on the DD waiver will lose their long-term case manager. This is inaccurate. The Kansas Developmental Disabilities Reform Act ensures that people with developmental disabilities can keep their targeted case manager under KanCare.
• DD clients will be forced to accept new service providers under KanCare. This is inaccurate. The terms of the three managed-care contracts guarantee DD clients the ability to keep their service provider.
• The managed-care organizations will be able to arbitrarily reduce the long-term services provided. This is inaccurate. Any changes in plans of care must be approved by the state.
• The MCOs will make eligibility determinations for individuals receiving long-term services. This is inaccurate. The current system of determining eligibility will remain the same by state law.
• It is not right to turn over long-term services to a for-profit entity. Many of the providers currently delivering services on the DD waiver are for-profit entities, demonstrating that it is possible to deliver quality services despite the fact that the entity makes a profit.
In 1995 the Legislature went through the same agonizing debate to change DD services with passage of the DD Reform Act. The families of DD clients were very upset over the idea of moving their loved ones out of institutional care to community care. Fortunately, the Legislature took the very difficult step to pass the legislation, which most would agree has been a very positive development for DD services in Kansas.
Earlier in this legislative session, we passed a bill establishing a joint committee on home- and community-based services and KanCare oversight. This legislative committee will have every opportunity to correct deficiencies within the KanCare program.
Our state has a track record of providing excellent support of our developmentally disabled citizens. KanCare provides the opportunity to improve health outcomes while capturing savings that can be used to reduce the waiting list for services. Change is difficult, but without innovation we cannot advance as a state.