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March 14, 2012
TOPEKA Members of the House Health and Human Services committee today were urged to approve a bill that would "carve-out" long-term services for the developmentally disabled from Gov. Sam Brownback's Medicaid makeover plan.
"If it ain't broke, why are we trying to fix it," said Richard Shank of Hutchinson, representing the Alliance for Kansans with Disabilities.
Shank and others told the lawmakers that the state's system for serving the developmentally disabled was a model program and that they feared the governor's KanCare plan would disrupt services for vulnerable people who do best when their circumstances are predictably stable.
KanCare proposes to move virtually all of the state's Medicaid population, including the elderly, disabled and mentally ill, into managed care plans overseen by three for-profit insurance companies. Administration officials are reviewing contract bids submitted by five companies and are crafting a request to federal Medicaid officials for waivers to implement their plan. The new system would be implemented Jan. 1, 2013, assuming federal authorities sign off and Kansas legislators don't block or postpone it.
Brownback officials have said state Medicaid spending has grown too quickly to be sustainable over time and that their plan would save the state and federal governments at least $850 million over five years. But they've also said those savings would be made without any cuts in services or rates paid to Medicaid providers. The savings, according to the plan, would result from better coordinated care that would help prevent or eliminate unnecessary or duplicated services.
In response to committee questions, Tom Laing, executive director of Interhab, said parents of most developmentally disabled people learned to suspect insurance companies through long years of contesting claims denied by insurers.
The prospect of seeing their children's sometimes around-the-clock living assistance overseen by insurance companies beholden to shareholders, he said, was one of the things the parents found most alarming about the governor's plan.
Interhab is an association that represents most of the state's Community Developmental Disability Organziations (CDDOs)
Advocates for the developmentally disabled so far have been the most vocal opponents of KanCare. They've said they support having medical services for the developmentally disabled included in the program but want a "carve-out" or exemption for the routine living assistance they receive under Medicaid. They have responded with skepticism to the administration's pledge that services or provider rates would not be cut, citing instances in other states where managed care companies have held up or denied payments.
Their protests recently were joined by the Kansas Association of Centers for Independent Living, which represents programs that serve the physically disabled. The association has drafted a letter to legislators asking that all home- and community-based services for the physically disabled also be excluded from KanCare.
The bill before the committee today was House Bill 2457, which would exclude services for the developmentally disabled from KanCare. It was introduced by Rep. Jim Ward, a Wichita Democrat.
A resolution asking the administration to postpone KanCare until July 1, 2013, has been introduced in the Kansas Senate and some House members are collecting signatures in support of a similar measure in the House.
The administration has responded to some of the criticisms or concerns about its proposal. The governor recently asked the Legislature to add about $3.4 million to his fiscal 2013 budget plan to pay for an education campaign aimed at Medicaid providers and to pay for an update to the Medicaid billing system that officials said would ease KanCare's administrative complexities.
Dr. Robert Moser, secretary of the Kansas Department of Health and Environment, and Shawn Sullivan, secretary of the Kansas Department on Aging, heads of two of the state's chief Medicaid agencies, were at the committee hearing but did not speak. They are scheduled to be before the committee on Thursday.
Spokesmen for the various managed care companies seeking a state contract likewise did not speak before the committee nor are they scheduled to do so.
More than a dozen individuals or groups offered testimony in support of HB 2457. The meeting room was filled to overflowing. Those who spoke had their comments restricted to two minutes by Rep. Brenda Landwehr, the Wichita Republican who chairs the committee. Landwehr said she had to limit remarks in order to give more people opportunity to talk.
Ron Pasmore, chief executive of KETCH, a Wichita nonprofit organization that provides services to the developmentally disabled, told committee members that he and others have been alarmed by developments in Kentucky where three managed care companies recently began running much of the state's Medicaid operations.
"Kentucky's version of KanCare has resulted in reduced access to medical care, compromised the quality of the care provided, and reduced the efficiency of Medicaid," he said. "Advocates state that the managed care companies promised all kinds of things that have not happened and the problems appear to be getting worse."
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