Kansas Health Institute | Information For Policy Makers. Health for Kansans.

TOPEKA — Key state legislators from both parties say they want to revamp the Joint Health Policy Oversight Committee so that is has a new focus on monitoring the performance of the state’s Medicaid managed care companies.

Gov. Sam Brownback announced his plan to expand managed care throughout the state’s $2.6 billion Medicaid program in November, and since then lawmakers have had few opportunities to weigh in on it.

Brownback officials have said they intend to keep the Legislature informed about their Medicaid makeover but don’t anticipate needing special legislation to implement it.

Companies interested in providing managed care services have until Jan. 31 to submit their proposals.

After the bids are turned in, state officials will begin closed-door negotiations with the bidders. The administration plan, called KanCare, is expected to be operational statewide by Jan. 1, 2013.

'A huge contract'

“As legislators we have a responsibility to provide oversight, to provide a check-and-balance, to hold state agencies accountable,” said Sen. Laura Kelly, a Topeka Democrat. “This is going to be a huge contract. The only thing we spend more money on is education.”

Administration officials said they plan to award contracts to three companies as they expand managed care to include the Medicaid services provided to the state’s elderly, disabled and mentally ill.

Currently, the state’s biggest managed care contracts are with the two companies that provide HealthWave services for low-income children and pregnant women who qualify for Medicaid or the Children’s Health Insurance Program.

Kelly said in the coming legislative session, which begins next week, she would propose giving the Joint Committee on Health Policy Oversight the role of monitoring the performance of the state’s Medicaid managed care companies and how well the administration meets its stated goals of improving Medicaid patient outcomes while reducing the program’s costs.

Brownback officials have estimated the move to more managed care will save state and federal taxpayers about $850 million over five years.

Kelly said the current 12-member committee should be restructured so that it includes more legislators from the House and Senate budget committees.

“We need to move from being a health policy oversight committee to being a health finance oversight committee,” Kelly said.

Currently, only four members of the joint committee also serve on Senate or House budget committees. They include Kelly and Sens. Vicki Schmidt, R-Topeka, and Ruth Teichman, R-Stafford, from the Senate Ways and Means Committee and Rep. Peggy Mast, an Emporia Republican, also on the House Appropriations Committee.

The joint committee was created in 2005 when the Legislature approved creation of the Kansas Health Policy Authority.

Initial purpose changed

The committee’s initial purpose was to monitor the new agency and its policy proposals.

But in July 2011, Brownback eliminated the health policy authority’s independent board of directors and merged what was the state’s lead Medicaid agency with the Kansas Department of Health and Environment. It’s now called the KDHE Division of Health Care Finance.

It’s expected that many of the decisions once made by state Medicaid officials at the health policy authority and now at KDHE eventually will be made by officials with the managed care companies.

“We have got to do something to rein in Medicaid costs, so I want this to work,” Kelly said of the administration’s planned Medicaid makeover. “I want it to be structured properly and fairly, and I want there to be positive outcomes. And for that to happen there’s going to have to be an oversight committee.”

Kelly’s idea has backing from Senate Vice President John Vratil and Rep. Brenda Landwehr, who is vice chair of the joint committee.

“Now that the health policy authority has been dissolved, it would make sense,” said Landwehr, a conservative Wichita Republican who also chairs the House Health and Human Services Committee.

'Appropriate balance'

Vratil, a moderate Republican from Leawood, also said he would endorse reforming the committee.

He said there’s little legislators can do to shape the way Brownback officials execute the Medicaid managed care contracts.

“Our system of government is dependent on there being an appropriate balance between the three branches of government,” Vratil said, noting that governors historically have proposed policy initiatives and legislators have kept them in check by deciding whether to fund them.

But current law allows a governor ample power to commit the state to contracts, and Vratil said Brownback has demonstrated he is willing to counteract the Legislature’s wishes in order to advance his goals.

As an example, he cited the governor’s decision last year to dismantle the Kansas Arts Commission after the Legislature voted to restore most of the organization’s funding.

“I just don’t recall that ever being done before by a governor,” he said.

Vratil said he also was troubled when officials at the Kansas Department of Social and Rehabilitation Services decided to use $600,000 that the Legislature earmarked for Early Head Start funding to underwrite programs to promote fatherhood instead of decrease the Early Head Start waiting list.

Vratil, an attorney, said he planned to propose language that could be added to legislation in the coming session that would cause appropriations to lapse if they weren’t spent on the purpose intended by the Legislature.

“There are other people on Ways and Means who are interested in doing the same thing,” he said.

Vratil is on the Ways and Means Committee and chairs the Senate Education Committee.

Engaged in the process

Kari Bruffett, assistant secretary for policy and external affairs at KDHE, said Brownback officials had “kept key legislators and committees informed throughout the extensive Medicaid reform effort this year and were pleased so many were engaged in the public process.”

She said she and other officials look forward to “working with the Legislature on key elements of the reforms, including work initiatives.”

Landwehr said she understood the frustration some fellow legislators might feel about being left in the dark on the details of the Medicaid managed care contract negotiations. But that’s the way the system works.

“I know that as a legislator, it’s always frustrating to have RFPs (requests for proposal) out there and not being able to know what’s going on. But it’s always been that way,” she said. “I don’t know how you’d get around it. This isn’t anything the Brownback administration has done. You can’t make it so RFPs fit the Legislature’s schedule, and I really don’t think we want to get legislators involved in contract negotiations.”