Kansas officials preparing to launch DD carve-in

Public meeting set for next week will also include federal Medicaid officials

1 | Legislature, KanCare

Linda Davis of Manhattan was among the KanCare enrollees or family members who shared personal stories Friday with members of the Robert G. (Bob) Bethell Joint Committee on Home and Community Based Services and KanCare Oversight. Davis said her grandson couldn't get proper medical services through KanCare and so was forced to become a ward of the state. "Our family was damaged," she said. "The state now has full financial responsibility."

Linda Davis of Manhattan was among the KanCare enrollees or family members who shared personal stories Friday with members of the Robert G. (Bob) Bethell Joint Committee on Home and Community Based Services and KanCare Oversight. Davis said her grandson couldn't get proper medical services through KanCare and so was forced to become a ward of the state. "Our family was damaged," she said. "The state now has full financial responsibility."

— Kansas Medicaid officials today said they are close to finalizing agreement with their federal counterparts on including long-term supports for the developmentally disabled in KanCare, the name given Gov. Sam Brownback's Medicaid managed care initiative.

"We've all bought off on the same framework," said Shawn Sullivan, secretary of the Kansas Department for Aging and Disability Services.

Officials at the federal Centers for Medicare and Medicaid Services made no official public comments to accompany the several made today by Brownback officials, who issued a press statement early in the day and then spent several hours before the Legislature's KanCare oversight committee discussing the planned KanCare expansion and a range of other program issues.

But in an email that was unofficially passed around among people who have been closely following KanCare developments, a ranking CMS official acknowledged that Brownback officials and CMS had made "substantial progress working through the important issues that have been raised by stakeholders."

"We have some issues remaining and before any final agreement is reached, the state and CMS will have a stakeholder call to go over specific issues," the CMS official wrote.

Kansas officials said they are taking steps to launch the controversial program expansion on Feb. 1, while still awaiting a final CMS approval document.

The "stakeholder call" referenced by the CMS official has been scheduled from 8:30 a.m. to 10:30 a.m. Wednesday. The call-in number to participate is (800) 811-9422.

The purpose of the teleconference, according to KanCare officials, is to inform the providers and beneficiaries of long-term developmental supports of various protections being put in place with the aim of safeguarding against some of the problems that emerged in the months after KanCare was launched.

Payment delays, service cutbacks and confusion over new procedures have been foremost among the complaints that have been raised to since the Brownback administration on Jan. 1, 2013 moved virtually all the state's Medicaid beneficiaries into managed care plans run by three major insurance companies: Amerigroup, United Healthcare and Sunflower State Health Plan, a subsidiary of Centene.

Long-term, residential services for the developmentally disabled were "carved out" of the initiative when it was launched after pressure on the administration from concerned legislators, though medical services for the developmentally disabled on Medicaid were included in the program from its outset.

About 400,000 people are currently enrolled in KanCare plans, about 20,000 more than when the program launched a little more than a year ago.

The waiting list

Sullivan told members of the Legislature's KanCare oversight committee today that his agency has put together a "corrective action plan" that is expected to satisfy earlier CMS concerns about the existence of the so-called "underserved waiting list," which by his agency's estimate includes about 1,400 developmentally disabled people who are receiving some but not all the home-based Medicaid services they are qualified to receive.


Shawn Sullivan, secretary of the Kansas Department for Aging and Disability Services.

View larger photo

The list has existed more than a decade but as part of the KanCare negotiations, Brownback officials have pledged to add no more names to it while taking steps to eventually eliminate the backlog.

Sullivan told the oversight committee it would take an estimated $14 million to $18 million from the state general fund to move everyone on the list off it, but he said there was some evidence that not everyone on the list would need or want the services immediately.

He said agency officials had evidence that some people put their names on the list "just to get in line" in anticipation of needing the services at a later point.

Addressing another issue raised by advocates with CMS, he said the KanCare ombudsman's office would remain at KDADS under his direct supervision despite calls from consumer advocates and others to have it operate independently of any of the state's Medicaid agencies.

Sullivan said there would be some "clarifications" about how the office operates as a result of the discussions with CMS, but no significant changes made in how the office is structured other than the addition of a volunteer director who will be tasked with developing a "volunteer network" to assist the office.

He also told lawmakers that Ombudsman James Bart would be taking another job at KDADS. He will become the agency's new managed care director. Bart will be replaced as ombudsman by Kerrie Bacon.

Other KanCare news

The KanCare oversight committee narrowly approved, 6-5, its recommendations for consideration by the full Legislature. Rep. John Edmonds, a Great Bend Republican, voted with the panel's four Democrats against the report. Rep. Jim Ward, D-WIchita, said he would write a minority report.

Among other things, the report stated strong support on behalf of the Legislature for including DD supports in KanCare by Feb. 1. It also recommended that any remaining money last year to help shrink the waiting lists for the physically or developmentally disabled be devoted to the DD underserved waiting list.

The panel also heard testimony from several KanCare enrollees or family members describing their experiences with the program.

One of the more compelling stories told was from Linda Davis of Manhattan. She told committee members that a mentally ill grandson formerly in her care became a ward of the state because of difficulties the family had getting him proper services through one of the KanCare managed care companies.


Danielle Buettner told legislators that one of the KanCare managed care companies "saved my life."

View larger photo

She predicted that unless the program is fixed, "families will be further stressed; some will disintegrate. The long-term social costs to Kansas will be huge."

About a half dozen KanCare enrollees, sometimes with the assistance of managed care company officials, described good experiences they had with KanCare.

Danielle Buettner, 37, told legislators that United Healthcare "literally saved my life."

She said her weight had dropped to 56 pounds because of an eating disorder and other problems and she had gone into the hospital for the "81st time."

She said her United HealthCare case manager began visiting once a week and helped her find housing after she left the hospital.

"Now my weight is at a healthy level and my doctor said they might be able to remove my pacemaker soon," she said. "I broke my hip a couple months ago because of osteoporosis, but other than that I haven't been to the hospital a single time and this is a huge change for me. Last year, I was in the ER at least twice a week."

KHI News Service coverage of KanCare

Hutchinson Clinic's letter throws a curve to KanCare open enrollment (1/28/14)
National Disability Council again urges CMS to hold off on Kansas DD carve-in (1/14/14)
DD carve-in not approved for Jan. 1 launch (12/27/13)
National Council on Disability urges one-year delay of KanCare DD carve-in (12/13/13)
KDADS chief describes lessons learned with KanCare (12/5/13)
Other states watching Kansas as it implements ‘unprecedented’ Medicaid model (12/5/13)
KanCare reimbursement problems continue for providers (11/25/13)
Kansas dental program for children on hold because of KanCare MCO (11/11/13)
Kansas Medicaid providers complain to oversight committee (10/7/13)
Wichita hospital execs describe problems with KanCare (8/29/13)
KanCare to adopt “health home” model for treating mentally ill (7/22/13)
Kentucky’s rush into Medicaid managed care: A cautionary tale for other states (7/18/13)
DD groups largely reconciled to KanCare carve-in (7/15/13)
Advocates urge more government oversight of Medicaid managed care (7/8/13)
Independent pharmacists push for KanCare contract enforcement (7/1/13)
Payroll agents for the disabled on Medicaid say they are struggling under KanCare (6/3/13)
Personal Care Attendants: KanCare's unheralded workers (5/20/13)
House GOP leaders pen letter backing DD supports in KanCare (5/17/13)
More than 1,000 rally at Statehouse for DD carve-out (5/8/13)
Nothing to be done about coverage gap in states not expanding Medicaid, feds say (4/29/13)
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. It is supported in part by a variety of underwriters. The News Service is committed to timely, objective and in-depth coverage of health issues and the policy-making environment. All News Service stories and photos may be republished at no cost with proper attribution, including a link back to KHI.org when a story is reposted online. An automatically updated feed of headlines and more from KHI can be included on your website using the KHI widget. More about the News Service at khi.org/newsservice or contact us at (785) 233-5443.


basketbutler (Susan Shaw)January 17, 2014 at 8:50 p.m.

What about the 1,470 HCBS service reduction requests made by KanCare last year, as reported in Legislative coverage today? Does that concern anyone? It sure does me.