Across Kansas, Medicaid-funded programs that help the disabled, brain-injured and frail elderly live in community settings and avoid expensive moves to nursing homes are encouraging their front-line case managers to go to work for the KanCare managed care companies.
“I’m helping them put their resumes together, I’m writing letters of recommendation for them, and we’re doing practice job interviews,” said Janet Williams, who owns communityworks, inc., an Overland Park company that provides case management and rehabilitation services for about 500 people with brain injuries.
“These are good, experienced people,” she said of the case managers. “I don’t want them to be unemployed. I want a soft landing for every one of them.”
Williams said at least 12 of her 25 case managers have accepted positions with Amerigroup, one of the three managed care companies that Gov. Sam Brownback has picked to run KanCare, his plan for remaking the state’s Medicaid program.
Williams said her firm won’t be doing any case management anymore once KanCare is up and running. Under KanCare, case management decisions that are now made at the local- or regional-program level will be made by the managed care companies.
KanCare’s proposed Jan. 1 launch remains contingent upon federal approvals and some other factors. Brownback officials are expected to decide Friday if the program will move forward on their intended schedule.
Other agencies also are shedding case managers. Some, perhaps most, are being hired by the managed care companies, though it’s not clear exactly how many.
The state’s Area Agencies on Aging historically have done the needs assessments for the state’s frail elderly who rely on Medicaid and also have provided case management services to the seniors. The AAAs also are urging their case managers to consider working for the MCOs, because the AAAs soon no longer will be handling case management and may not have positions for all of them as needs assessors, though some could be needed in those roles as the AAAs expand their assessment role.
“The AAAs have encouraged their case managers to respond to the job fairs that the managed care companies have been putting on,” said Janis DeBoer, executive director with the Kansas Area Agencies on Aging Association.
The 11 AAAs, DeBoer said, currently employ about 150 case managers. It’s not yet known how many will land jobs with the managed care companies.
The state’s 11 Centers for Independent Living face what are expected to be the biggest changes. The CILs historically have worked with physically disabled. Some have provided assessments, case management, direct care and other services.
“We’re essentially going back to our 1998 staffing levels,” said Audrey Schremmer-Phillips, who runs 3Rivers Inc., a center for independent living based in Wamego that serves several counties. “And our plan is to go back to doing what we were doing in 1998 -- that’s information and referral, independent living skills training, peer counseling, and individual and systems advocacy.”
In the late 1990s, Schremmer-Phillips said, 3Rivers had about 18 employees helping 600 attendant care workers care for people with physical disabilities in their communities in a nine-county area. It’s since grown to 24 employees helping more than 900 caregivers.
By January 2012, she said, the program will down to 14 workers.
“We’ll be strapped for a while and we’re expecting a bit more chaos than we have now, but we’ll make it,” Schremmer-Phillips said. “We’ll survive, and if there’s one thing I can guarantee it’s that, as advocates, we will be loud.”
The CILs receive federal grants for their advocacy work and that is not expected to change with the introduction of KanCare.
Better pay and benefits
Some case managers said they had been offered better pay and benefits by the MCOs.
Nanette Unruh has been a case manager with the Prairie Independent Living Resource Center in Hutchinson for the past five and a half years. She said she had accepted a position at Amerigroup, where she plans to start in late November.
“I would have stayed at PILRC for the rest of my life,” Unruh said. “I love my job, but I cannot go without health insurance.”
Amerigroup, she said, offered her “the same job I have now, more or less,” with more pay, a better benefit package, and an in-home office that’ll put an end to her current 17-mile commute to and from PILRC.
“I’m kind of scared because I know it’ll be hard to relearn things,” Unruh said. “But at the same time, I’ll have health insurance and I get to continue working with this population.”
Deone Wilson runs the Resource Center for independent Living in Osage City, one of the largest CILs in the state. She said eight of the program’s 15 case managers already had accepted similar positions with the managed care companies.
“The first one leaves (Oct. 12),” Wilson said. “I’m expecting the rest of them to leave because they know that when case management goes away (at the CILS), their jobs will be going away.”
Wilson said the Resource Center for Independent Living would continue to act as “payroll agent” for physically disabled persons who choose to self-direct their Medicaid-funded care.
“We do that now for about 1,000 consumers,” she said.
In Kansas, the elderly, brain-injured, and physically disabled that receive in-home Medicaid services are allowed to choose their caregivers or let a home-health agency choose the caregivers for them. It’s not unusual for those who self-direct their care to choose a relative, friend, or neighbor over someone they don’t know.
A payroll agent helps the Medicaid enrollees recruit, hire, train, and pay their caregivers.
Shawn Sullivan, secretary of the Kansas Department for Aging and Disability Services, has said that under KanCare, Medicaid beneficiaries’ ability to choose their in-home caregivers will remain in intact.
But some CIL officials said they weren’t counting on their agencies having a continued role in the new KanCare system as payroll agents. Currently, the state contracts with about 65 agencies or firms for the payroll agent services. It remains unclear whether the three managed care companies will continue those contracts.
“The question now is from the perspective of the managed care companies – these are huge national corporations - how much longer are they going to want to contract with any willing (payroll agent)?” said Ami Hyten, assistant director at the Topeka Independent Living Resource Center. “Wouldn’t it make more sense for them, a year or two from now, to say, ‘OK, we’re going to contract with single (payroll agent) for the whole state?’ It would be cheaper for them. I don’t know that that’s what’ll happen, but we’re not planning on it not happening.”
The Topeka Independent Living Resource Center began scaling back its case management services about three years ago and now focuses primarily on payroll work and advocacy.
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