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Originally published April 9, 2012 at 4:10 p.m., updated April 16, 2012 at 1:41 p.m.
TOPEKA County officials across Kansas are raising doubts about KanCare, Gov. Sam Brownback’s plan for letting insurance companies manage the state’s $2.8 billion Medicaid program.
“Before the administration gets to the point of signing contracts with these companies, it should let the Legislature, a special committee or the public know what’s in them so we can have the professionals on the ground tell us where the potholes are. We shouldn’t be putting our vulnerable populations at risk,” said Ed Eilert, a Republican member of the Johnson County Commission and a former Overland Park mayor, a post he held 24 years.
Administration officials currently are reviewing bids submitted by five managed care companies. They have not yet released or approved the proposed contracts but have said that before the summer is up they intend to choose three companies to run KanCare beginning Jan. 1, contingent upon federal approvals. The administration’s request for proposals was issued in November. It outlined what the governor hopes to do with the Medicaid program.
Brownback officials have said the plan will save the state and federal governments $850 million over five years while improving health outcomes for those on Medicaid, mostly as a result of better care coordination. They also have said they foresee no significant reduction in Medicaid services or in the rates paid to Medicaid providers.
Johnson County is Kansas’ most heavily populated county. Eilert said he expected the commission there soon would pass a resolution urging the governor to “carve out,” or exclude from KanCare, the long-term care services Medicaid provides for people with a developmental disability.
According to local officials contacted by KHI News Service, at least 24 counties have passed similar resolutions asking the governor to reconsider the reach of KanCare. At least three more are considering a resolution.
The first resolution was jointly endorsed March 5 by commissioners in Marion and Harvey counties. The Topeka-based Kansas Association of Counties later distributed copies of the document to the state’s other 103 counties. Within a month, 22 other counties approved their own resolutions and more are expected to follow.
It’s not clear if the resolutions will change the administration’s approach. When the Legislature returns April 25 for its wrap-up session, lawmakers are expected to debate a proposal that would exclude long-term services for the developmentally disabled from KanCare.
An effort to debate the measure on the House floor was stymied by a procedural move at the end of the regular session, but supporters have pledged to bring it up again.
“We appreciate our partners in the counties, and we look forward to continued dialogue for how we improve outcomes for the most vulnerable Kansans,” said Miranda Steele, a spokesperson for the Kansas Department of Health and Environment, the agency overseeing the KanCare contracting.
Others in the administration also were asked to comment about the developments among the counties, but they did not respond.
Some county commissioners who have approved the resolution described themselves as conservative Republicans and Brownback political allies.
“We examined what’s being proposed (with KanCare), and frankly we couldn’t find the savings,” said John Reynolds, chairman of the Saline County Commission, which passed the resolution last week.
“We could see how it would limit expenses and how it would send millions of dollars to out-of-state insurance companies, but to say that this is somehow going to be good for people with developmental disabilities is crap.”
Reynolds, an attorney, is a member of the board of directors at OCCK, a Salina-based program that provides services for the developmentally disabled in nine counties.
“This isn’t about politics,” he said of the commission’s action. “I’m a dyed-in-the-wool conservative. I worked for Brownback when I was in law school. I campaigned for him. I like the guy. I think he does good work. But on this he’s dead wrong.”
‘Layer of bureaucracy’
The resolution easily gained approval of Harvey County commissioners, according to a member of the board, largely because county government there a few years ago had a hand in designing the local service system for the developmentally disabled. That system now works well, said Commissioner Marge Roberson, and the concern is that KanCare would disrupt an already solid program.
“We had some controversy with our CDDO (Community Developmental Disability Organization) about six or seven years ago,” Roberson said. “We brought the community together and talked about how to restructure it. After many meetings, we created a new CDDO that’s quasi-public and open. It really works well, so we have a vested interest in what we have. The main thing I’m hearing (about KanCare) is lack of communication and a lot of distrust.”
She said she and fellow commissioners shared a concern that KanCare would bring a “layer of bureaucracy that’s sure to cloud things up.”
“I’m a Republican,” Roberson said. “I’ve always been a Republican. But it’s becoming more and more difficult to be a responsible Republican because, bottom line, the ultra-conservative wing of the party has become very vocal, and there’s a certain amount of fear and distaste in arguing with them because it’s an argument, it’s not an exchange of ideas. What we want are solutions, not politics.”
‘A little gun-shy’
Commissioners in Wallace County, which borders Colorado and has a population of about 1,500, approved the resolution last week partly because they feared the potential costs, according to the panel’s chairman.
“I guess you could say we’re a little gun-shy when it comes to the state saying it wants to cut costs because usually that means those costs are going to get passed down to the local level,” said Commissioner Adam Smith. “It’s the counties that end up holding the bag.”
“A lot of the (state developmental disability) funding has already been cut,” said Smith, a farmer-rancher who lives near Weskan. “So what happens is the (local program) people come in and say, ‘You have X number of people receiving services, and we can’t keep providing those services if the county doesn’t put up the money.’”
In Kansas, county budgets are dependent on sales and property tax revenues.
“The problem with that is that out here, a sales tax doesn’t generate much revenue – a 1-cent sales tax raises about $80,000,” Smith said. “That puts an extreme strain on the property tax. We have people whose property taxes are already close to 200 mills. You just can’t go much higher than that.”
Wallace County is one of several included in House District 118, which is represented by Rep. Don Hineman, a Dighton Republican. Two other counties in his district – Gove and Trego – also have passed the resolutions.
The counties’ actions have not gone unnoticed among legislators.
“There’s a pretty widespread uneasiness on the county level as to how KanCare is going to affect people in the DD (developmentally disabled) and PD (physically disabled) communities,” Hineman said.
“It’s seen as a giant step that’s being taken all at once, even though really a lot of people think the home- and community-based services part should be carved out, make sure the system works the way everybody hopes it does and then add them in at a later time.”
Hineman said there are special concerns in the sparsely populated counties he represents.
“The big concern,” he said, “is that out here in the rural west, if a provider goes out of business there may not be anybody to step in and take their place. It’s not Kansas City, Wichita or Topeka.”
The state’s 27 CDDOs, directly or through subcontractors, provide most of the Medicaid services available to the developmentally disabled.
Interhab, an association that representing most of the CDDOs has been the most outspoken critic of the KanCare plan.
They’ve said they would support the plan if it only included the medical services provided to their clients. But they’ve been consistently opposed to including the long-term care services that help people with day-to-day living assistance, including job training.
In some counties, such as Sedgwick, the CDDOs have brought the resolution before commissioners and asked them to support it. Sedgwick County officials said the commission there might be discussing the resolution when it meets Tuesday.
The KHI News Service is an editorially independent initiative of the Kansas Health Institute and is committed to timely, objective and in-depth coverage of health issues and the policy making environment. Find more about the News Service at khi.org/newsservice or contact us at (785) 783-2529.