Several developments this week will help officials in the administration of Gov. Sam Brownback decide if their KanCare Medicaid reforms will move forward on the original timeline of a Jan. 1 launch or whether the program will get pushed to a later, yet-to-be-decided date.
A few things are scheduled to happen over the course of the next five days that will shape that decision, according to Brownback officials. Among them:
Sometime this week, perhaps by Wednesday, completion of the last of the state’s “readiness reviews” of the three managed care companies is due.
Officials have said they will not proceed on schedule unless Amerigroup, United Healthcare and Sunflower State Health Plan, a Centene subsidiary, each has demonstrated it is ready. (The companies had an Oct. 12 deadline for demonstrating that their networks of hospitals, doctors and other service providers were “90 percent adequate,” but administration officials said they wouldn’t make public the status of the companies’ respective network capacities until the end of this week, so it isn’t yet clear how well each company fared with the deadline.)
On Thursday, the day before the administration’s go/no-go decision on whether to begin assigning beneficiaries to the managed care plans, top Kansas health officials are set to meet in Baltimore, Md., with federal officials from the Centers for Medicare and Medicaid Services, the Office of Management and Budget and others.
Reviewing the waiver request
The purpose of the meeting is a review of the state’s so-called Section 1115 waiver application. Much, if not most, of the KanCare plan requires federal approval, either as part of the waiver application, the state’s ongoing Medicaid plan on file with federal officials, or the KanCare contracts and rates. The federal government gets a large say in keeping with the fact that it pays more than half the state’s annual Medicaid costs, which next year are expected to reach $3.2 billion.
Brownback officials have not disclosed when they will decide whether KanCare can proceed on the Jan. 1 schedule in the manner they have proposed. That, according to one official, "is a moving target." They have made public that they intend to decide by Friday whether they will begin assigning Medicaid beneficiaries to the managed care plans later this month as previously scheduled.
Those making the trip east on behalf of Kansas, according to Brownback officials, are Lt. Gov. Jeff Colyer and his top aide Mark Dugan. Also attending from the Kansas Department of Health and Environment are its top Medicaid officials, including Dr. Bob Moser, the secretary; Kari Bruffett, head of the Health Care Finance Division; Medicaid Director Dr. Susan Mosier; Deputy Medicaid Director Christiane Swartz; and Mike Randol, director of finance and informatics in the Health Care Finance Division. Traveling from the Kansas Department for Aging and Disability Services are Secretary Shawn Sullivan and Dave Halferty, a Sullivan deputy and KDADS’ chief financial officer.
'Caveats and decision points'
Though administration officials have said the launch date for KanCare is contingent upon the various factors still in play as of this week, at the same time they’ve made clear to legislators and others that they have no major fallback plans in place in the event the program is delayed.
“With all those caveats and decision points along the way, we're marching forward for Jan. 1 and all our efforts are for implementation on Jan. 1,” Bruffett told members of the Joint Legislative Budget Committee last week during an update on the KanCare program.
For example, KanCare is expected to supersede HealthWave, the state’s program for providing government subsidized health coverage to children and pregnant women from low- and moderate-income homes. The state’s contracts with the current HealthWave managed care companies, Unicare and Children’s Mercy Family Health Partners (recently purchased by Coventry Health Care), are due to expire Dec. 31. There is no plan to extend those contracts in the event KanCare is delayed.
“We’ve not had any of those kinds of conversations,” Bruffett told KHI News Service. <a name="continued"></a>
If necessary, Kansas could continue HealthWave services with the more expensive alternative of paying fees for services instead of relying on managed care contractors, “but that isn’t a good option,” Bruffett said.
As much KanCare as possible
When asked by Sen. Laura Kelly, a Topeka Democrat who serves on the budget committee, what administration officials would do if federal officials do not approve the 1115 waiver on the Brownback timeline, Bruffett said the administration’s intention was to launch as much of KanCare as possible without federal approvals on Jan. 1.
“Everything we have authority to do in the KanCare model, we will do,” she said.
But at this point, it isn’t clear how much of the program could be initiated without the OK from the feds. Bruffett told lawmakers she was “uncomfortable speculating” at this point about what all might be done without federal sign-offs.
What is clear is that some major elements of KanCare’s implementation already are underway.
For one thing, many of the state’s Medicaid service providers (and some state agencies) already are beginning to lose case managers and other workers to the managed care companies, which reportedly are paying better wages and providing better benefits than the current employers.
For example, Gary Haulmark, commissioner of community services and programs at KDADS, soon is scheduled to leave the post for a new job as Kansas director of government relations for Amerigroup, one of the KanCare contractors. At least two other KDADS employees also are leaving for the MCOs. Michael Deegan is going to Amerigroup and Angie Reinking is going to United HealthCare. Deegan has been the agency’s program manager for home- and community-based Medicaid services for those with traumatic brain injures. Reinking has been the Money Follows the Person project director.
'Only good outcome'
Given that at least some of the horses have left the barn, Bruffett said one of the chief points that Brownback officials would try to make with federal officials at the Baltimore meeting is that moving forward with the Jan. 1 timeline is the only good option.
“The only good outcome is that we hit Jan. 1,” she told members of the budget committee. “That is the date that is known. That is the date that providers are making plans for. If we have to deal with something else, we will.”
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