Gov. Sam Brownback today said his administration has been given the green light by federal officials for the Jan. 1 start of KanCare, his plan to remake the state's Medicaid program.
Kansas officials said they would continue to work with the Centers for Medicare and Medicaid Services to finalize the "special terms and conditions" of the waiver ahead of the program's launch. But they said they will move forward with their plan to move virtually all the state's 380,000 Medicaid beneficiaries into managed care plans run by three insurance companies: United Healthcare, Amerigroup and Sunflower State Health Plan, a subsidiary of Centene.
Children and pregnant women enrolled in the state's HealthWave program will be transferred from whichever of the two current managed care contractors they work with now to one of the new plans.
Those assignment notices were mailed last month along with thousands of others to beneficiaries previously outside a managed care plan, including the elderly in nursing homes, the disabled and people who rely on Medicaid home- and community-based services.
Shawn Sullivan, secretary of the Kansas Department for Aging and Disability Services, said in order to ease the transition to the new system all plans of care for Medicaid enrollees would remain intact through the first 90 days of KanCare or until the managed care companies' crafted new plans under state oversight.
That transition period could extend to 180 days for people receiving home- and community-based services, he said, in the event it took the companies and the state that long to put new care plans in place.
He said the state also had agreed to treat all nursing homes providing Medicaid services as "in-network" for the first year of KanCare regardless whether the facilities had signed provider contracts with the managed care companies.
Dr. Robert Moser, secretary of the Kansas Department of Health and Environment, said the administration's earlier projections of $1 billion in savings over five years as a result of KanCare were still on track with about $400 million of that accruing to the state and the rest to the federal government.
Lt. Gov. Jeff Colyer, who has been the governor's point man on the new program, attended the press conference via speaker phone.
He said the program would improve care coordination for Medicaid patients and result in better health outcomes while avoiding the need for rate cuts to Medicaid providers.
Brownback officials were asked about expanding Medicaid eligibility under the terms of the Affordable Care Act to include more people in KanCare, but remained noncommital.
The governor has said he is still studying that possibility in consultation with other states.
CMS 'Courtesy call'
Federal officials did not take part in Friday's announcement, but Vikki Wachino, director of the children and adults health programs group at CMS, made a personal phone call to at least one Kansas advocacy group ahead of the governor's press conference, to inform them of the decision.
"We did receive a courtesy call before the governor's press release, letting us know the announcement was coming," said Anna Lambertson, executive director of the Kansas Health Consumer Coalition, a group that had called for a six-month delay in KanCare's launch so that Medicaid enrollees could be better educated about the upcoming changes.
Lambertson said Wachino told her CMS would forward her the final terms of the federal government's agreement with the state once it was finalized, but did not say when that would be.
"I'm not terribly surprised by today's announcement," Lambertson said. "It was becoming clear that CMS was working closely with the state trying to assure that some aspects of the state's proposal could move forward."
Lambertson said it seemed apparent that some concerns raised earlier by advocacy groups had been heard by federal and state officials.
For example, when Kansas submitted its so-called Section 1115 waiver application, it asked for authority to limit to 45 days the time within which KanCare enrollees could switch plans after being assigned to one by the state. State officials subsequently agreed to stick with the standard 90-day period more common to state Medicaid managed care plans.
Lambertson said the group would continue to push for a KanCare ombudsman independent of any of the state's Medicaid agencies.
State officials agreed to have an ombudsman, but have chosen to locate the office within the Kansas Department for Aging and Disability Services.
Soon a reality
Brownback officials said the only Medicaid enrollees specifically excluded from KanCare were Native Americans who choose to opt out of the program. Also, medical services for the developmentally disabled on Medicaid are included in the program, but not the long-term supports they receive but which are paid for by Medicaid.
Families and advocates for the developmentally disabled were some of the most vocal and earliest opponents of KanCare, which resulted in legisaltors and the administration agreeing not to include the long-term supports for at least the first year of KanCare.
"Up to now, this has been an academic exercise," said Matt Fletcher, associate director of Interhab, which represents most of the state's Community Developmental Disability Organizations. " But come Jan. 1, this will become a reality for thousands of Kansans who rely on Medicaid for their health care. So one would hope CMS would have a watchful eye on KanCare beginning in 2013."
Interhab was among the groups that pushed for KanCare's launch to be delayed so that providers and Medicaid enrollees could be better prepared for it.
Shannon Cotsoradis, chief executive of Kansas Action for Children, a Topeka-based advocacy group, said it remained unclear whether Medicaid enrollees were prepared for the coming changes.
"The federal government has determined today that Kansas is ready to move forward with KanCare, but what is less clear is whether children and families are ready for this transition," she said in a prepared statement. "As KanCare unfolds, it will be important to monitor the impact it has on children’s access to health care coverage.”
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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