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Feb. 3, 2014
TOPEKA The consulting firm headed by former Health and Human Services Secretary Mike Leavitt has delivered a report to the Kansas Hospital Association outlining what it considers might be politically viable options for expanding the Kansas Medicaid program to include thousands of additional people.
KHA Chief Executive Tom Bell confirmed he has a draft of the report and that discussions are underway about how best to use it. Broader release or public discussion of the options outlined in the report likely won’t come for at least a couple more weeks, he said.
The report describes how Kansas might use the private sector to expand Medicaid coverage to include people earning up to 138 percent of federal poverty guidelines.
The Kansas Medicaid program, called KanCare, currently is limited to the poor who are elderly or disabled. Eligibility rules for it are among the tightest in the nation and exclude childless, able-bodied adults altogether.
“It’s a really good overview of all of the options,” Bell said, noting the report stopped short of recommending a specific option.
“We believe the best kind of plan is one that policymakers and stakeholders put together themselves,” Bell said. “We’re trying to put together a structure for the dialogue.”
The state’s $3 billion KanCare program already relies heavily on private-sector involvement. Three for-profit, managed-care companies run the day-to-day operations. About 400,000 Kansans are enrolled in health plans managed by the insurance companies: Amerigroup, UnitedHealthcare and Sunflower State Health Plan, a subsidiary of Centene.
Robin Arnold-Williams, a partner in the Leavitt firm, and the former head of state social service agencies in Utah and Washington, said Kansas officials might want to consider options already adopted or being considered in other states.
“There are a range of (Medicaid expansion) choices and options that can be packaged together in different ways and each state has taken a little different approach to which pieces they select, how they put them together and for what populations,” she said, “We’ve also been reviewing alternative approaches and options that haven’t shown up yet either in (federally) approved waivers or legislation but are under discussion in various states.”
Some states are asking the federal Centers for Medicaid and Medicaid Services to let them require that enrollees who earn above the poverty level pay a portion of their premium. Others want to impose a work requirement or offer a different set of Medicaid benefits to new beneficiaries below the poverty level.
Arnold-Williams said she and Leavitt might come to Kansas to brief legislators and others on the options in the report. Leavitt, a Republican, served in President George W. Bush’s Cabinet and was a two-term governor of Utah.
She said Leavitt recently was in Arkansas to discuss that state’s expansion initiative with legislators.
Kansas is one of 23 states that have not chosen to expand Medicaid to include adults earning below 138 percent of the federal poverty line — $15,856 for individuals and $35,325 for a family of four.
They are ineligible for Medicaid because they earn too much but are too poor to qualify for federal subsidies to help cover the cost of private coverage purchased in the new online marketplace created by the Affordable Care Act, more commonly known as Obamacare.
There has been a recent trend among once-reluctant Republican governors to embrace program expansion and hospital officials and other advocates for it had said they hope that spreads to Kansas.
Some plan to use federal Medicaid dollars to cover the cost of purchasing private coverage for the newly eligible beneficiaries.
At a recent question and answer session with Statehouse reporters, Kansas Gov. Sam Brownback said he wants to wait and see how much flexibility the federal government is willing to give states in the way they configure their expansions.
“The (Obama) administration is altering Obamacare on a weekly basis, so let’s watch and see what else they do,” Brownback said. “I frankly think that’s a prudent course.”
Some Kansas interest groups that opposed the Affordable Care Act now seem warmer to the idea of at least discussing Medicaid expansion, perhaps spurred by reports showing that without it Kansas medical providers could lose out on billions of dollars.
Mike O’Neal, head of the Kansas Chamber, said he would welcome discussion about how the state might move forward with a more private-sector approach.
“We don’t want to say ‘no, we’re not interested in this, let’s bury our head in the sand and not worry about it.’ This is an important issue and there needs to be a discussion,” O’Neal said.
O’Neal is a former Kansas House speaker and — like GOP leaders in the House and Senate — he said no plan likely will gain traction without Brownback’s urging.
“That’s probably what needs to happen,” he said.
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