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June 20, 2012
TOPEKA Top health officials from the administration of Gov. Sam Brownback today tried to reassure nervous members of the Kansas public that the Medicaid makeover plan they hope to launch Jan. 1 is a good idea and that problems seen in other states that have expanded managed care would be avoided here.
"We have put in place policies to avoid the stumbling blocks that have tripped up other states," said Secretary on Aging Shawn Sullivan to a crowd of about 180 people gathered at Topeka's Memorial Auditorium. Others participated via telephone conference calls.
"Our intention is not to turn over the keys to private insurance companies," Sullivan said. "This is a partnership (with the insurance companies). This is not an abdication of our responsibilities."
Sullivan repeated the second part of that statement more-or-less verbatim at least twice during the course of the two-hour session, most of which was devoted to letting members of the public speak out about KanCare.
Leverage the private sector
The governor's plan, if implemented, would move the balance of the state's Medicaid population into fixed-cost managed care programs divided statewide among three companies. About 70 percent of the state's Medicaid population already is in managed care plans. KanCare would move the remainder into a system that would be similar to the current one but also different because it would improve health outcomes and lower costs thanks to a new emphasis on coordinated care, the officials said.
"We are going to leverage private-sector innovation and resources," said Dr. Robert Moser, secretary of the Kansas Department of Health and Environment.
But few in the audience seemed satisfied by the various assurances described in turn by Sullivan, Moser and Kari Bruffett, director of the KDHE Division of Health Care Finance. Each of those three officials is expected to play a key role in implementing KanCare, should it garner the needed federal approvals to proceed.
The hearing today was the second this week designed to meet some of the federal requirements for public input on so-called Section 1115 waiver applications submitted by states. Kansas turned in its initial application in April but then withdrew it pending necessary opportunity for input from the public and representatives of the state's American Indian health centers.
Sullivan told KHI News Service that administration officials plan to meet with Indian health officials in White Cloud on Thursday and have tentatively scheduled a meeting Friday in Topeka with officials from the Haskell health center, which is in Lawrence. He said a third meeting with spokesmen from the various recognized Kansas tribes and officials from the federal Centers for Medicare and Medicaid Services was scheduled for 10 a.m. June 26 at the Prairie Band Potawatomi reservation outside Mayetta.
Moser told the crowd that four new KanCare workgroups would be announced later this week and that at least one would meet before the month was up. He said the groups would include various "stakeholders" who would advise the administration on aspects of KanCare.
"We continue to welcome public comment," he said.
Suspicious and worried
The comments today were from people who seemed suspicious or worried about the administration's plan.
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"Sounds like you're adding one more layer of bureaucracy and I don't understand how that will save money," said a woman who was patched in via speakerphone and identified herself as social worker Jessica Welch.
Welch said she mostly worked with elderly clients and she worried that the plan's 45-day enrollment cut-off wouldn't allow them enough time to select the best managed care plan. Under KanCare, those who don't choose a plan within 45 days would be "auto-assigned" to one of the three companies.
"I feel there's going to be a lot of outreach needed," Welch said. "And we don't have a lot of information on what the plans will look like."
Brownback officials also heard from various people who said they were parents of adult children with developmental disabilities.
"This is a highly disruptive change and it ignores good business practice because there's been no pilot program," said a woman who called in but whose name wasn't clearly audible. "The more I look at it, the more it looks like ObamaCare."
She said the current system was working fine and warned the Brownback officials, "that if it ain't broke, don't break it."
A caller from northwest Kansas said he thought the plan looked like "some socialist bureaucracy bundle" and that he was concerned his child's current medical providers wouldn't be included in whatever networks the managed care companies end up with in the state's more remote corners.
Details and transparency
Tom Laing, executive director of Interhab, an association that represents most of the state's Community Developmental Disability Organizations, said group members were concerned about the lack of details released as the administration negotiates the KanCare contracts.
Brownback officials have said they will not reveal the details of their negotiations with the five managed care companies, which three companies of the five they have chosen, or make public the contracts they enter into until after the agreements are signed sometime in July.
"We believe the lack of transparency is a concern," Laing said, "and particularly for us because for the last 20 years all our contracts (with the state) have been negotiated in public."
Laing also was among those who said the administration's timeline for KanCare was too fast.
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"This is the largest financial transaction in the history of the state of Kansas," he said. "We would hope state and federal officials would take more time."
"It's very difficult to comment on a plan that doesn't have very much detail," said Nick Wood of the Disability Rights Center of Kansas. "Overall, it's just not there."
Jill Quigly, a former member of the Kansas House, spoke on behalf of Oral Health Kansas.
She said it already was difficult to find dentists to take Medicaid patients and "we're concerned this additional bureaucracy will weaken the dental provider network."
Administration officials, in the final minutes of the meeting, responded to some of the concerns raised.
Bruffett said the Medicaid clients would get plan notices in the mail sometime this fall and would have the months of November and December to review them before the 45-day clock on choosing a plan began ticking on Jan. 1. She said that would effectively give people 90 days to choose a plan.
Officials also said they would require each of the managed care companies to have "robust" networks of providers at least equal to the current Medicaid network. They also said there were financial rewards to assure that the companies promptly pay medical service providers. Payment delays have been a problem in some other states that have Medicaid managed care.
Some of the concerns were to be expected, Sullivan told the crowd.
"Anytime there are major changes, there is a heightened sense of anxiety," he said. "This is a time of change."
Administration officials said they would continue to accept written comments on the KanCare proposal at KanCare@kdheks.gov through July 14.
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.