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Nov. 28, 2012
TOPEKA The federal official in charge of reviewing 1115 Medicaid waiver requests sat in on an hour-long conference call today to hear Kansans' views on Gov. Sam Brownback's proposed Medicaid makeover plan.
Only about 20 people had time to comment but none of them expressed support for KanCare, which would move virtually all the state's 380,000 Medicaid beneficiaries into managed care plans run by three insurance companies.
Most people who called in questioned the need for KanCare and expressed concern that they or family members would lose services or their case managers. Others called for a delay, saying the program's planned Jan. 1 launch date would come too soon.
Vikki Wachino — director of the children and adults health programs group at the Centers for Medicare and Medicaid Services — in rare public comments about KanCare, said CMS had asked Kansas officials to organize today's call so she and other CMS officials could hear public response to the state's preparations in anticipation of an upcoming decision from CMS on Kansas' waiver request. She didn't say when the decision would come, but hinted it could be soon.
"We asked them to do that now at this time...so we can decide where we go from here," Wachino said during the teleconference introductions. "We've spent a lot of intensive and thoughtful time with the state on their proposal and have heard from them loud and clear their desire to move on a Jan. 1 start date. And we would like to make the decision soon whether that time frame is the right time frame for Kansas and whether the alternative of not moving forward on that timeframe would create transition implications of their own. So I really invite you on this call to share your thoughts and concerns."
Wachino said no more after her introductory remarks, during which she noted that she and other CMS officials on the call were in "listen-only mode."
Kari Bruffett — director of the division of Health Care Finance at the Kansas Department of Health and Environment — said earlier in the day during a separate teleconference with Medicaid providers that she expected CMS to deliver a decision on the state's KanCare request "within a matter of days, not weeks."
CMS officials did not participate in that earlier teleconference.
If federal officials were to weigh only the public comments about KanCare, both during today's call and those posted on the CMS website after the state filed its application, the request would be rejected or at least postponed. Response in those venues has been overwhelmingly critical of the plan or its implementation.
But Brownback officials have said their intention is to improve care coordination and services for the state's Medicaid enrollees without cutting rates paid to Medicaid providers and all while saving the state and federal governments $1 billion or more over the next five years.
Federal officials consider public comments in their reviews of 1115 waiver requests, but their decisions aren't necessarily dictated by them. Former Kansas Gov. Kathleen Sebelius, now secretary of the U.S. Department of Health and Human Services, has ultimate say-so on 1115 applications under federal law. Those waivers are intended to encourage state "demonstration" projects that could show how to improve the Medicaid program perhaps in ways useful to the federal government or to other states.
A woman who identified herself only as "Gloria from Garden City" said she was pleased with the current system and asked "why fix it, if it ain't broke."
Many others expressed similar sentiments, saying they or family members were well served by their current case managers and were concerned they would lose long-standing relationships with them once the managed care companies take over.
The majority of the callers said they or their family members were physically disabled.
Others expressed concerns about the way the transition to KanCare is being handled.
Suzanne Wikle of Kansas Action for Children said the advocacy group was worried that current HealthWave enrollees would be confused by the rebranding of the program as KanCare. HealthWave, which is already handled by managed care companies, provides services to children and pregnant women from low-income homes. The new program would add the elderly, mentally ill and physically disabled on Medicaid into managed care plans run by a new group of companies.
Mitzi McFatrich of Kansas Advocates for Better Care, which speaks on behalf of nursing home residents, said information about the proposed changes had been lacking in useful detail or was sometimes delivered in untimely fashion.
Several people said the implementation schedule was too fast given that so few people seem to understand the plan and given that many Medicaid providers still haven't agreed to participate in the managed care networks.
One woman said, "I'm pretty concerned there will be some big panic in the first part of the year. I hope you take into consideration some delays."
State officials were on hand to respond to some of the remarks but let some pointed ones pass without comment. Mostly they said they wanted to be attentive to people's concerns and thanked them for calling.
"We were told we had to send out notices to consumers saying that as of Dec. 31 we could no longer provide case management services (because those duties will transfer to the managed care companies)," said one caller. "What happens if this doesn't pass and KanCare has already shut down numerous businesses? Where are the consumers supposed to turn?"
That question met silence until the conference call operator moved on to the next caller.
→ As KanCare continuity of care period ends, problems persist; legislators starting to hear about it (4/8/13)
→ Advocates raise concerns over possible reductions in KanCare services (3/28/13)
→ Conferees agree on KanCare oversight committee (3/28/13)
→ DD advocates push to extend KanCare "carve-out" (3/20/13)
→ Safety-net clinics struggling with KanCare (3/4/13)
→ Major medical provider groups ask for longer KanCare transition (2/13/13)
→ Lawmakers and providers assess KanCare transition (1/28/13)
→ Five-part series: "Lower cost and better care: Can KanCare deliver?" (1/14/13)
→ Independence of KanCare ombudsman questioned (1/7/13)
→ KanCare special terms and conditions spelled out by CMS in a document (12/28/12)
→ KanCare workforce shift hampering local agencies (12/10/12)
→ Governor announces KanCare approval by feds (12/7/12)
→ More KanCare implementation details outlined (12/3/12)
→ Federal officials say they hope to act soon on KanCare waiver request (11/28/12)
→ New KanCare info included on state website (11/20/12)
→ Groups call for KanCare delay (11/8/12)
→ Go/no-go date looms this week for KanCare (10/15/12)
→ KanCare benefit packages outlined (9/26/12)
→ Provider groups nervous about lack of KanCare details (9/13/12)
→ KanCare Confidential (9/10/12)
→ KanCare contracts awarded (6/27/12)
→ KanCare plan panned again at public hearing (6/20/12)
→ Wichita KanCare forum draws more than 200 (6/19/12)
→ Medicaid makeover: Can Kansas learn from Kentucky? (6/11/12)
→ Hundreds protest inclusion of disability services in KanCare (4/25/12)
→ Counties weighing in on KanCare (4/9/12)
→ Hospital administrator to chair KanCare Advisory Council (3/29/12)
→ Brownback Medicaid makeover an “ambitious” plan (3/28/12)
→ KanCare bidders heavily courting Medicaid providers (3/19/12)
→ Legislators push to delay KanCare start (3/7/12)
→ Brownback announces managed care for all in Medicaid (11/8/11)
→ Kansas Medicaid makeover in the works (3/7/11)
→ Full Medicaid and KanCare coverage
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.