KanCare waiver request to be ready soon, officials say

Senate budget writers briefed on Medicaid waiver status and other fiscal matters

0 | Budget, KanCare, Medicaid-CHIP

— The waiver application needed for Gov. Sam Brownback's proposed Medicaid makeover is nearly complete and could be filed with federal officials before the month is up, Brownback administration officials said today.

Still unclear, an administration source said, was whether public hearings on the waiver application would be required in order to satisfy new federal regulations governing so-called Medicaid 1115 waiver applications.

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KanCare plan needs federal approval

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"We're still waiting to hear back from CMS on that," the source said. "It depends on whether they'll accept our earlier public forums as meeting the requirements."

CMS is the federal Centers for Medicare and Medicaid Services, the agency with which states negotiate Medicaid waivers. The administration last summer had a series of public forums across the state before announcing its Medicaid makeover plan in November. But those meetings were staged to gather suggestions before the plan was public.

The new federal regulations requiring public input are scheduled to become effective April 22. They stipulate that states must have at least two public hearings on 1115 waiver applications at least 30 days before the applications are submitted to federal authorities. Then, federal officials would have to allow another 30 days for public input on the proposal.

This morning, Mark Dugan, chief of staff for Lt. Gov. Jeff Colyer, told the Senate Ways and Means Committee that the administration was still preparing the waiver application.

Earlier this year, administration officials told legislators they believed they would not need to file a full application with CMS but instead could negotiate with the agency based on the brief concept paper they submitted in late January outlining the changes they would like to make to the Kansas Medicaid program.

KanCare is the name the governor's team has chosen for its Medicaid makeover proposal. The administration currently is reviewing contract bids submitted by the five insurance companies vying to be one of three selected to manage Medicaid services statewide. The administration's goal is to launch the new program on Jan. 1, 2013. It would bring managed care to virtually all the state's 380,000 Medicaid beneficiaries, including the elderly in nursing homes, the developmentally disabled and the mentally ill.

The plan has been endorsed by the Kansas Medical Society and has qualified support from the Kansas Hospital Association. But advocates for the developmentally disabled have fought hard against having long-term care services included in the plan. About 30 Kansas counties have approved resolutions asking the governor to exclude or "carve-out" from KanCare the long-term services for the developmentally disabled. Legislators are expected to debate a bill requiring the "carve-out" when they return next week for the wrap-up session.

In response to questions today from Sen. Vicki Schmidt, a Topeka Republican, Dugan — speaking for the administration — told the committee that if federal officials reject the 1115 waiver application, the administration will seek so-called "1915" waivers instead.

Schmidt said she wasn't sure if the administration could get all the federal approvals it seeks in time to launch KanCare by Jan. 1.

"I'm not sure what that timeline looks like" for getting all the needed approvals, Schmidt said. "But Jan. 1 will be here before we know it."

A majority of the Kansas Senate has approved a resolution urging Brownback officials to postpone KanCare's launch until July 1, 2013.

KanCare would replace HealthWave, the current state program that provides Medicaid managed care services to children and pregnant women from low- to moderate-income households.

There are two companies providing HealthWave services, and their contracts are scheduled to expire June 30.

In related news, officials at the Kansas Department of Health and Environment on Monday confirmed that they had submitted their proposals to extend the HealthWave contracts until Dec. 31 to each of the two managed care companies, Unicare and Coventry Health Care of Kansas, which acquired Children's Mercy Family Health Partners.

"CMS requires rates to be certified as actuarially sound for the six-month extension period," said Miranda Steele, spokesperson for KDHE. "That actuarial analysis is complete, and we have forwarded the extension and rates to the plans."

A spokesman for Unicare said the company was reviewing the extension document and had asked for some additional information from state officials. A spokesman for Children's Mercy wasn't immediately available for comment.

"We did receive our contract extension documents last night (Monday) along with the rates," said Douglas Klise, director of field operations for Unicare in Kansas. "We have asked (KDHE) for some additional information to provide to our actuary team for analysis and are awaiting those documents."



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