Ideas abound for changing Medicaid system

Coverage of stomach-bypass surgery for the chronically obese; increased use of technology to deliver medical care; integrating health, housing and other services for the frail elderly; ending coverage for circumcision.

Those are among 120 suggestions the state has received in response to a call for ideas for reforming the Medicaid system in Kansas.

The ideas submitted by the public and by health care providers form the groundwork for a series of meetings and discussions to be held this summer, said Lt. Gov. Jeff Colyer. The goal is to build a comprehensive plan to improve services while cutting costs in the system that provides care for poor, elderly and disabled Kansans, he said.

Colyer, a doctor and former state legislator, was appointed in January by Gov. Sam Brownback to head up the Medicaid reform effort.

"Medicaid is a program that is over 40 years old," Colyer said.

When it was created, treatments such as rehabilitation, reconstructive surgery and insulin therapy didn't exist, he said.

"Lots of things have been added on or grafted on," Colyer said. "We need to update the program to fit the world we have today."

To facilitate that, Brownback has asked the federal government to give the state its Medicaid funding as a block grant. That would give Kansas flexibility to make changes without having to seek federal permission, which can take as long as a year, Colyer said.

Colyer said he hopes to have some pilot projects get under way later this year.

The state spends $2.8 billion — about 18 percent of its total budget — on Medicaid, Colyer said. Costs have increased about $400 million in the past two years.

Ideas submitted by the public for dealing with the situation ranged from major proposals, such as creating an Office of Integrated Community Services to administer all home- and community-based assistance programs, to benefit tweaks like the suggestion to eliminate coverage of circumcision.

Not all the ideas will be implemented and some appear to be mutually exclusive. For example, some advocates proposed increased use of institutional care, while others want to expand home- and community-based care programs.

Several advocates proposed ideas to expand managed care; others proposed making greater use of the concept of a "medical home" to oversee patients' treatment and reduce duplication of service.

Other ideas included using predictive modeling to cut fraud, and strengthening the system to recover assets from deceased Medicaid recipients' estates, to help pay the government back for care they received before death.

Several proponents recommended increased use of technology, such as telemonitoring of groups at risk for specific health problems and connecting rural health providers to each other and to patients through secure messaging and teleconferenced doctor visits.

Recommendations for changes to benefits included several focused on weight reduction, which also can reduce beneficiaries' risk of chronic medical conditions such diabetes and kidney disease. Coverage for weight-loss surgery and medical nutrition therapy were among those proposals.

Another proposal calls for greater coordination of services for the frail elderly, some of whom receive assistance through Medicaid, Medicare and other programs.

The idea there is to take a comprehensive approach to the seniors' needs, including health, nutrition, housing and other aspects of home-based care.

This story was originally published April 8, 2011 at 12:00 AM with the headline "Ideas abound for changing Medicaid system."