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July 7, 2011
WICHITA Lt. Gov. Jeff Colyer came here Thursday looking for ideas how to remake the state’s Medicaid program.
He left with a long list of them.
“This was incredible,” Colyer said, minutes after wrapping up the second of four public forums aimed at finding ways to trim between $200 million and $400 million from the state’s Medicaid budget.
“We had almost 400 people show up, and every one of them wanted to see Medicaid improve and to keep it affordable,” Colyer said. “That’s a tremendous commitment. It’s really going to have an impact. It’s going to allow us to move forward.”
The forum, held at a Holiday Inn in east Wichita, featured small-group discussions on issues affecting services for children, pregnant women, people with disabilities and frail seniors.
Participants included consumers, service providers, lobbyists, medical professionals and a dozen legislators.
A sampling of the audience’s recommendations:
• Enact policies that discourage non-emergency visits to emergency rooms.
• Remind families of their moral obligation to at least share in the costs of caring for frail elders.
• Reward behaviors that improve health. Discourage those that do not.
• Increase the numbers of nurse practitioners in the state’s rural areas.
• Let Medicaid beneficiaries know how much their services cost.
• Do more to promote “living wills” and hospice care, less to promote nursing home care.
• Limit families' ability to switch managed care providers more than once a year.
• Do more to encourage businesses to hire disabled people.
• Approach companies like Home Depot and Lowe’s about helping people with disabilities make their homes accessible; installing wheelchair ramps, for example.
• Foster home-like homes for frail seniors or disabled people who might otherwise move to a nursing home.
• Reduce the potential for fraud and abuse by not allowing family members to be paid for caring for elderly relatives.
• Close one or both of the state hospitals for people with severe developmental disabilities.
• Find ways to better coordinate patient care.
“Right now, we see patients who have four or five case managers each one of them coordinating a different part of that person’s care,” said Dave Sanford, executive director at GraceMed, one of the state’s largest safety-net clinics. “If we could somehow find a way to break down the silos and streamline the Medicaid system, we’d provide quality at less cost. I’m sure of it.”
Watch for fraud
Wendell Turner, a retired aircraft worker, said more should be done to “police” the state’s Medicaid rolls.
“Just the other day, I was standing in line at the grocery store and there were two ladies in front me,” Turner told KHI News Service. “They used their Vision Card (food stamp card) to pay for their groceries, but when it came time to pay for their cigarettes and a 12-pack of beer they pulled out their cash.
“That shouldn’t happen,” he said. “If you got enough money for beer and cigarettes and beer, you should have enough money for food. I have to wonder how much of that is going on with Medicaid?”
Turner, 77, is active in the state’s Silver-Haired Legislature.
Doubled in a decade
In Kansas, more than 300,000 adults and children receive Medicaid-funded services, costing taxpayers more than $2.8 billion last year.
The federal government covers roughly 60 percent of the program’s cost. The remainder – about $1.1 billion -- comes from the state.
Medicaid is the second largest general fund expenditure, trailing only K-12 education.
The program’s cost has nearly doubled since 2000.
Low-income families – children and pregnant women, mostly – account for two-thirds of the state’s Medicaid caseload but less than one-fourth of the program’s cost.
The elderly and disabled account for roughly one-third of the caseload; three-fourths of its cost.
Able-bodied, childless adults under age 65 are not eligible for Medicaid.
Headed for deficit
The program’s ever-increasing costs coupled with the state’s aging population have placed unsustainable demands on the state budget, said Kansas Department of Health and Environment Secretary Robert Moser.
“If we don’t do something, we’re headed for a $900 million deficit by 2016,” Moser said, quickly noting that the state constitution does not allow deficit spending.
“We’ve got to think big,” he said.
At a press conference Wednesday, Brownback reminded reporters that earlier this year, his administration had used $205 million in Kansas Department of Transportation funding to offset increases in the state’s Medicaid caseload.
A similar transfer, he said, won't likely happen again.
“We were able to do this one time,” Brownback said.
The governor said he would rather lower the program’s cost through increased efficiency than by denying services to someone in need.
Moser echoed the governor’s sentiments Thursday.
“Improve health care outcomes and reduce costs,” he said. “That’s clearly our goal here.”
Earlier this week, Kaiser Health News reported that “about a dozen” cash-strapped states had reduced their Medicaid payments to doctors, hospitals and other providers.
Last month, some top ranking officials at the Kansas Department of Social and Rehabilitation Services sent emails to some of the agency contractors, warning of a pending 2.5 percent cut in their Medicaid reimbursements.
SRS officials later said the cut had been considered but that a final decision on its implementation had not been made.
On Wednesday, neither Brownback nor SRS Secretary Rob Siedlecki ruled out the possibility of a cut in Medicaid reimbursement.
“Let me see what they come back from these conferences (with),” Brownbacks said, referring to the Medicaid forums.
A third forum is scheduled Friday at the Magouirk Conference Center in Dodge City.
A final forum is planned in either Johnson or Wyandotte County in late August. A time, date and location have yet to be announced.