Push is again coming to shove in the struggle over whether the long-term care and support services received by Kansans with developmental disabilities will become part of KanCare or remain outside the control of the private companies hired by the state to manage the Medicaid program.
Advocates pushing for a permanent “carve out” of developmental disability services have circled May 8 on their calendars. That’s the day that the Kansas Legislature is scheduled to return to Topeka to wrap up its 2013 session.
“When you show up in numbers, it makes a difference in the legislative process,” said advocate Tom Laing, speaking last week to approximately 175 parents and advocates at a meeting sponsored by Johnson County Developmental Services.
“A lot of times when politicians do the wrong thing it’s because they haven’t heard from the folks who are the most impacted. If they don’t hear from you, we can’t succeed,” said Laing, executive director of Interhab, an association that represents most of the state's Community Developmental Disability Organizations.
Laing and other advocates said they are hoping that thousands of Kansans with developmental disabilities would turn out with their parents and guardians for a rally on the south steps of the Statehouse and to meet individually with legislators to make their case.
“I’m not a guy who believes in pitch forks and torches. We need to be persuasive, not abrasive,” Laing said.
'Carve in' date approaching
Medical services for the developmentally disabled already are part of KanCare, the reform initiative launched on Jan. 1 by Gov. Sam Brownback. It moved virtually all of the state’s 380,000 Medicaid beneficiaries into managed care plans run by three insurance companies: Amerigroup, United Healthcare and Sunflower State Health Plan, a subsidiary of Centene.
But yielding to pressure from advocates and service providers, the governor and legislators agreed last year to delay the inclusion of long-term, DD support services for a year — until Jan. 1, 2014. With the “carve in” date approaching, advocates are pressing their case again. <a name="continued"></a>
“We have to keep these services out of the hands of the profiteers,” said Bridget Murphy, director of the Downs Syndrome Guild of Greater Kansas City.
'Misinformation' fueling concerns
Murphy’s concern that the for-profit managed care companies will disrupt services now generally provided by a network of community-based, non-profit organizations is shared by many parents and advocates.
That frustrates Shawn Sullivan, the secretary of the Kansas Department of Aging and Disability Services, who has spent more than a year meeting with stakeholders to convince them they have nothing to fear from the new managed-care system. Despite what advocates are saying, Sullivan said services won’t be cut back under KanCare and long-standing relationships between case managers and service providers won’t be disrupted.
“I think there has been a lot of misinformation that has been spread by the main provider association (Interhab),” Sullivan said. “I think some of that has been intentional and that has been very unfortunate.”
Sullivan said the administration does not intend to drop its plan to fully integrate DD services into KanCare and that he didn’t think that advocates would be successful convincing legislators to intervene.
“I do not anticipate that there will be legislative action to permanently carve out or delay DD services in KanCare,” Sullivan said. “We remain committed within our agency and administration to make sure this works well.”
But some legislators who attended the Johnson County meeting said they thought it was possible that lawmakers could still act to either force another delay or a permanent carve-out.
Rep. Nancy Lusk, an Overland Park Democrat serving her first term, said legislators on both sides of the aisle have concerns, including some conservative Republicans who normally can be counted on to back the Brownback administration.
“It can be done,” Lusk said. “This is so critical, there’s no going back once they carve it in. I hope and pray the Legislature will be receptive.”
Laing said three options remain: legislators negotiating a budget agreement could include a proviso blocking the carve-in, a bill stuck in committee that would do the same could be passed or Brownback could decide not to move forward with his administration’s plan.
Misinformation claims countered
Erin Crapser is both the mother of a daughter with developmental disabilities and a case manager for more than 20 others who need support services.
She said the problems she encountered trying to get her daughter’s “complicated medical needs” covered under KanCare convinced her that the concerns about also integrating long-term care and support services were valid. Specifically, she said it was hard to determine which managed care organization covered all of the providers and services that her daughter needed.
“You couldn’t just call the insurance companies and ask because their lists were incomplete and they were inaccurate. So, you had to actually call all of your providers and find out which groups they were actually contracting with. And sometimes the answer would be, ‘Well, we plan to contract with them and we hope the contract will be done by April 1st but we don’t know for sure.’”
Sullivan acknowledged that the roll-out of KanCare has not been problem free.
But he said the state and the MCOs had taken a “workman-like approach” to solving problems once they surfaced and would do the same with the integration of long-term care and DD support services, which he predicted would be “a lot less complicated” to implement than medical and behavioral care services had been.
“You’re mainly talking about day services and residential support services and two or three billing codes as compared to the large transition that took place in January,” he said.
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
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