Hopes for Medicaid fix

Because “Medicaid has been eating us alive,” as Gov. Sam Brownback recently put it, reforming the state- and federally funded health care program for the poor and disabled had to be an urgent priority for his new administration. If the comprehensive overhaul unveiled last week achieves its big goals, Kansans as well as the Kansas budget will be healthier for it.

Many assumed that the only way the governor and Lt. Gov. Jeff Colyer, a physician and the overhaul’s architect, could reduce costs was via across-the-board cuts. But as Colyer said before the rollout, “That’s not going to improve health care in the state of Kansas.”

What will, Kansans can hope, is the administration’s new managed-care strategy under what it’s calling KanCare. With the help of private contractors coordinating “outcomes-focused, person-centered” care for the state’s 350,000 Medicaid patients, as well as efficiencies afforded by a shuffled state infrastructure, the administration expects to save $367 million in state funds over a five-year period – all “without cutting provider rates, throwing people off the system or reducing essential benefits.” The plan would slow the growth of Medicaid costs by about one-third.

Among the big changes: As the Department of Health and Environment oversees the financial and contract management of KanCare, its program management would fall to the expanded Department for Aging and Human Services, which also would handle disabilities and behavioral health services and the five state hospitals for the mentally ill and developmentally disabled. Meanwhile, the Department of Social and Rehabilitation Services would become the Department for Children and Family Services. KanCare also would take over for HealthWave, which covers moderate- to low-income children and pregnant women.

To its credit, the plan emphasizes the use of home- and community-based services, which are less costly for the state and often more preferable and beneficial than nursing homes for the frail elderly and individuals with disabilities.

One key to cost control will be the proposal to give Medicaid patients incentives to lose weight, stop smoking, and participate in programs to manage chronic conditions and otherwise improve their health.

The plan, set to launch in January 2013, would require legislative action and federal approval as well as an executive order by Brownback.

Lawmakers should seek input from stakeholders, who are understandably apprehensive about so much change all at once. With multiple managed-care contractors and multiple state agencies dealing with human services, the reform risks more paperwork for providers and more bureaucratic hassles for patients.

But with Kansas’ cost of Medicaid having risen an average of 7.4 percent a year for a decade now, costing Kansas taxpayers about $1 billion of the full $2.8 billion bill this year – and with little prospect of increased federal funding – Brownback had to do something.

Kansans should hope his ambitious plan works, because the status quo is making the state budget sicker by the year.