Politics & Government

KanCare up for renewal despite performance shortfalls

Disabled Kansan has waited more than seven years for state services

McRae Wooten, 21, has been waiting for state services since 2008. She is diagnosed with mental retardation, developmental delays, autism and seizure disorder. She is one of more than 4,000 Kansans waiting for services. (Video by Gabriella Dunn 3/1
Up Next
McRae Wooten, 21, has been waiting for state services since 2008. She is diagnosed with mental retardation, developmental delays, autism and seizure disorder. She is one of more than 4,000 Kansans waiting for services. (Video by Gabriella Dunn 3/1

The state will negotiate new contracts for its privatized Medicaid system that some describe as inefficient and ineffective. The contracts will take effect in 2018.

Medicaid in Kansas is called KanCare. It provides health insurance for low-income and disabled residents.

KanCare recipients have complained about longer wait times and more reimbursement denials since privatization in 2013.

KanCare recipients have reported longer wait times and more reimbursement denials since the privatization in 2013.

Sunflower, UnitedHealthcare and Amerigroup currently provide Medicaid plans in Kansas. It’s unclear if other insurance companies would be willing to offer plans in Kansas’ privatized system. The three companies reported losing $52 million in Kansas in 2014.

To compound financial issues, Gov. Sam Brownback cut Medicaid reimbursements to providers by 4 percent to help fill the state’s budget hole. The cuts will go into effect in July but will exempt critical access hospitals in rural areas along with nursing homes and home- and community-based disability services.

Michael Randol, director of the Kansas Division of Health Care Finance for the state health department, said he did not yet know if the three KanCare providers planned to pursue contract renewals, which would start in 2018.

All three companies, Randol said, fell short on some performance requirements specified in their contracts with the state. In reaction to public discontent about those shortfalls, he said, “We will do what we need to, to address those concerns.”

But he wouldn’t say what it is that he would do.

All three companies fell short on some performance requirements specified in their contracts with the state.

Nonetheless, Randol said he felt each organization had made improvement. The state is supposed to have a full-time watchdog over the KanCare program, but that position of inspector general has been vacant since January 2014.

Wednesday in Wichita, KanCare recipients, parents of children with disabilities and health care providers shared grievances about the current program and concerns about the future.

Compounding issues

Among the concerns expressed at the Wednesday hearing:

▪ Gov. Sam Brownback cut Medicaid reimbursements 4 percent, to help fill the state’s budget hole.

Community members at the public hearings expressed concern that lower reimbursement rates will result in fewer doctors willing to accept Medicaid patients.

▪ The state passed a “step therapy” law that requires Medicaid recipients to try cheaper generic drugs before being allowed to receive more expensive brands. It will go into effect July 1 and is expected to save about $10.5 million.

Patients and health care providers complained that the move takes away the physician’s professional judgment and instead transfers decision-making to the health insurance companies. Opponents of the law also say that it could cause patients to suffer while trying ineffective drugs and that the appeals process could be unwieldy for low-income, elderly and disabled people.

▪ Medicaid applications are backlogged. The problems began when the state switched oversight of Medicaid eligibility from the Department for Children and Families to the Department of Health and Environment at the beginning of the year.

Providers questioned the state’s ability to efficiently manage changes. One provider at the public hearing said the approval of applications is delayed between six and nine months. He also said the merged eligibility departments has led to one-hour hold times at the call center. He reported being allowed only one question before the caller hangs up.

Randol, the state director of the Division of Health Care Finance, said he couldn’t address individual call times but didn’t know of waits of up to two, three or four hours long. He wouldn’t say if one-hour waits were typical.

▪ Many service providers for the disabled have received the same Medicaid reimbursement rates since 2008.

Providers said organizations that offer services have staffing shortages and high turnover from stagnant payments as costs to provide services have gone up.

▪ Kansans with intellectual or developmental disabilities face average wait times of seven years to receive state funding for services.

What’s next

The state will develop draft applications in June and July, post the applications for review around August or September, submit them to the U.S. Centers for Medicare and Medicaid in November and establish the contracts, terms and conditions in 2017 to take effect in 2018.

Gabriella Dunn: 316-268-6400, @gabriella_dunn

  Comments