TOPEKA — When someone suffers a traumatic brain injury, it’s Heather Matty’s job to help find a case manager who will help the injured person find and figure out how to pay for the in-home services they need to stay out of a nursing home.

In recent weeks, she said, she’s noticed a shortage of case managers.

“A lot of them are leaving to go to one of the (KanCare) managed care companies,” said Matty, resource and advocacy liaison at the Brain Injury Association of Kansas and Greater Kansas City. “And programs that used to have case managers all over the state – they’re not doing that anymore. They’re pulling back, so there aren’t as many case managers as there used to be. They’re downsizing.”

The shortage, she said, was driven Gov. Sam Brownback’s plan for letting three managed care companies - United HealthCare, Amerigroup, and Sunflower State Health Plan (a subsidiary of Centene) – run virtually all of the state’s Medicaid programs, including home and community-based services for the brain-injured and physically disabled.

Under KanCare, the managed care companies are scheduled to take over the local programs’ case management responsibilities.

Though KanCare’s proposed Jan. 1 launch remains contingent upon federal approvals and some other factors, the MCOs already have hired many case managers away from the local programs.

Matty last week she was having trouble finding case managers for brain-injured patients in Linn, Edwards and Reno counties

“Everything has slowed down,” she said. “And if you can find a case manager, it’s hard for them to find somebody to provide the services either because no one’s available, because of the travel costs, or because a lot of agencies don’t want to take new people on for just a couple months” (before KanCare starts).

Matty said she didn’t know how many people with brain injuries have been caught in the lurch between case managers leaving and KanCare’s launch. She guessed it would be “in the teens.”

At the same time, she said, brain-injured people who are receiving in-home services are being told that under KanCare, they’ll likely be assigned different case managers.

“For people with brain injuries, these kinds of transitions are really difficult,” she said. “There’s a lot of confusion, right now.”

Deone Wilson, who runs the Resource Center for Independent Living in Osage City, said each of her 15 case managers were responsible coordinating services for about 75 people with physical disabilities.

Eight of the agency’s case managers, she said, are leaving for similar positions with Amerigroup.

“What’s happening is that as one of them leaves, 75 people get divided up among the case managers who are left,” Wilson said. “So for the next two and half months, everybody’s going to be really busy – and they were really busy before all this started happening.”

Colleen Booz Vittich, a case management supervisor at the University of Kansas Hospital in Kansas City, said she, too, had noticed increased delays in being able to find services for patients needing in-home services.

“It’s been getting harder and harder to get people connected with services in their community,” Vittich said. “The biggest problem we’re having is that there’s a one- to two-year waiting list for some of the (Medicaid-funded) services for the physically disabled. So even if we can get (patients) assessed and set up with a case manager, the reality is that they still have to wait.”

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