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

TOPEKA — The heads of the Kansas Medical Society and the Kansas Hospital Association testified today in favor of Gov. Sam Brownback's plan to expand Medicaid managed care to include long-term services for the developmentally disabled, the elderly and the mentally ill.

Those endorsements put the state's leading medical provider groups at odds with the state's 27 Community Developmental Disability Organizations (CDDOs). Those groups and their supporters have been the plan's most outspoken and organized opponents. About 400 people gathered Saturday at a church in west Wichita to voice concerns. Similar meetings have occurred or are planned in other parts of the state.

But the chief spokesmen for the doctor and hospital groups said it was clear to their members that changes were needed in the Medicaid program and that the governor's plan offered potential for better coordination of care and improved health for Medicaid patients.

Administration officials claim KanCare, the proposed plan, will be accomplished without major cuts in payments to medical providers, including doctors and hospitals. Thanks to better care coordination and elimination of unneeded services, they say, it will produce cost savings of about $850 million over five years.

"Business as usual probably isn't going to work with Medicaid," said Jerry Slaughter, executive director of the medical society, speaking to members of the Senate Public Health and Welfare Committee. He cited the program's growing costs and its anticipated expansion in 2014 to include about 130,000 more Kansans.

The program currently provides services to about 350,000 Kansans at an annual cost of about $2.8 billion in combined federal and state spending.

The governor announced his plan Nov. 8, and the administration the same day began soliciting bids from managed care companies. Officials say they plan to sign contracts with three companies to provide Medicaid services statewide beginning Jan. 1, 2013. The completed bids are due Feb. 22, and administration officials have said they would like to award contracts as early as July in order to launch the changes six months later.

The plan has been the subject of ongoing hearings by the Senate Public Health and Welfare Committee since the Legislature started its new session last week. The hearings are scheduled to continue through this week and at least until Monday. Other committees also have scheduled hearings on the topic. Today, the Senate Public Health and Welfare Committee for the first time heard testimony from Medicaid service providers about KanCare.

Tom Bell, president of the hospital association, also spoke in favor of including long-term care services in the managed care contracts. He expressed some reservations about the overall plan, however, saying among other things, "This is not something there is little skepticism about. We don't want to just slash provider rates across the board. ... This depends an awful lot on the companies picked to do this."

"This is a program we think can work," Bell said. "But the state's got to maintain oversight and there has to be customer service" provided by state employees. "The minute the managed care companies lose credibility with the hospitals and other providers, then it won't work."

Tom Laing, executive director of Interhab, the CDDO association, followed Slaughter and Bell at the podium. He told committee members that the medical services provided by doctors and hospitals were different from the daily living assistance provided by the CDDOs.

"We understand the logic of placing medical spending into KanCare," Laing said. "However, long-term care services are not medical. Our services are solely related to the identified daily living needs of persons we serve."

Laing said a typical Medicaid patient wouldn't see a doctor or other care provider more than a few times a year, but that the developmentally disabled on Medicaid deal with their care providers daily, sometimes around the clock.

He also said the KanCare goals of coordinated care and reduced costs already have been accomplished by the CDDOs, so KanCare would only add new layers of needless complexity and paperwork while giving insurance companies too much say in the lives of the vulnerable.

Laing said the CDDOs don't oppose the governor's plan, but they don't want the long-term services they provide included in it.

Administration officials testified earlier today to the Senate Ways and Means Committee.

They said services for the developmentally disabled needed to be included in the plan in order to assure all those enrolled in Medicaid receive coordinated care no matter what type of services they require.

The Senate Public Health and Welfare Committee is scheduled to hear more KanCare testimony on Wednesday, including from spokesmen for the state's community mental health centers and others.