A week into major changes of the Kansas Medicaid program questions persist about whether a new consumer advocate will have the freedom and the resources to do his job.
Lawrence attorney James Bart was recently hired as the ombudsman for the new KanCare program being implemented by Republican Gov. Sam Brownback. Officials say the Jan. 1 expansion of managed care to include virtually all the state’s Medicaid enrollees is intended to slow the growth in Medicaid costs and improve the care provided to the more than 380,000 low-income, elderly and disabled Kansans in the program.
But some legislators and consumer advocates are questioning whether housing the ombudsman’s office in one of the state agencies responsible for KanCare implementation will hinder Bart’s effectiveness. They also question whether he will have sufficient resources to handle what could initially be large numbers of consumer complaints with the new system.
Bart, the only full-time employee in his office at the Kansas Department for Aging and Disability Services, was asked directly about the adequacy of his resources today during a meeting of the KanCare Specialized Care and Network Issues Workgroup in Topeka.
Sheldon Weigrau, a workgroup member, said if only 1 percent of the state's Medicaid enrollees filed complaints with the ombudsman, that would mean at least 10 complaints or problems a day to handle. He questioned whether Bart would have the resources to deal with that many of them, "otherwise, you're going to be overwhelmed."
Bart said 10 issues landed on his desk during the first working week of KanCare, which ended Jan. 4, and all had been resolved. And he said he had assurances from KDADS Secretary Shawn Sullivan that he could draw on on more of the agency's resources if needed.
"I can't solve every issue," Bart said. "But I can be the grease in the wheels. If it gets to the point where I feel I can't deal with the issues with the resources I've got, then I'll go get more resources."<a name="continued"></a>
Question of independence
Sen. Laura Kelly, a Topeka Democrat, is among the legislators asking questions about the ombudsman's office.
“It’s just beyond me to see how someone who is housed in an agency and who is dependent on that agency for the resources they need to do their job can be truly considered to be independent,” Kelly said after the issue was raised at a recent meeting of the Legislature’s Joint Committee on Health Policy Oversight.
KDADS administers Medicaid programs that provide support and long-term care services to elderly Kansans and those with physical and developmental disabilities. The agency also oversees state programs for the mentally ill and the state hospitals.
Anna Lambertson, executive director of the Kansas Health Consumer Coalition, said having Bart work at KDADS compromises his ability to effectively represent consumers in disputes with the managed care companies and the state.
“In our opinion, the position that has been created is not an independent ombudsman,” Lambertson said. “We feel very strongly that for KanCare to work consumers need someone who is independent of the Medicaid program to handle their complaints and to serve as an independent voice for them.”
Special Terms and Conditions of KanCare approval by CMS
Federal officials also stressed the need for an independent ombudsman during their review of the state’s application to proceed with KanCare. In a Dec. 27, 2012 letter, officials from the Center for Medicare and Medicaid Services said the ombudsman “must exist outside of the Kansas Department of Health and Environment,” the state’s primary Medicaid agency. However, they approved the state’s plan to house the consumer advocate in KDADS.
Questioned by Kelly and other members of the oversight committee, Bart said he understood why people might have concerns. But he said his experience advocating for his developmentally disabled son had given him a consumer perspective that would help him be effective in the job.
“I come at this with a passion,” he said. “I have a 19-year-old son who is currently a resident of Parsons State Hospital. I’m living this on a personal and a professional level. My heart and soul is with the consumer.”
Bart also said housing his office in a state agency could be an advantage because it would allow him to forge better working relationships with the people running KanCare and to more easily advocate for additional resources should they prove necessary.
“I feel very strongly that I have the advocacy skills not only to advocate for consumers but also to advocate for the resources necessary to do my job,” Bart said. “I don’t think we should anticipate that the resources won’t be there.”
Bart has acknowledged some limits on his independence. He told a KHI News Service reporter he couldn't answer questions from the media without first clearing it with Angela de Rocha, the communications director for KDADS and the Kansas Department for Children and Families.
Bart said the fact that he had initially been openly skeptical of KanCare also should add to his credibility.
In September 2012, Bart posted a message on a public comment portion of the CMS website predicting “KanCare will become a demonstration of how not to reform Medicaid.” He also endorsed a post written by someone else that read in part: “Nothing good will come of handing Medicaid over to private companies to profit off the poor and elderly.”
Bart said the criticism stemmed more from his frustrations with the Medicaid system that existed at the time than with the KanCare proposal.
“The system had failed me and my son,” he said, explaining that a lack of community services made it impossible for him to care for his son at home.
In the months since his critical postings Bart said, “I have learned a lot about how KanCare offers hope and promise to my son.”
KDADS secretary Sullivan said Bart’s personal experiences dealing with the system should help alleviate concerns about whether he could be an effective advocate for consumers.
“Who better than the parent of a child enrolled in the program to guard the interests of his own child and everyone else,” Sullivan said.
Despite the assurances, Lambertson and Kelly said they remained concerned about Bart’s ability to freely advocate for consumers and to handle the workload. Both said they planned to closely monitor his performance.
“I don’t think I can rely on the agency to give me that information,” Kelly said. “But I have other sources who can let me know whether the position is working the way that it ought to be. That it truly is a consumer advocacy position and not just an arm of the agency.”
Bart told members of the KanCare workgroup today that he planned to present public updates on his work each Friday as part of the daily KanCare teleconferences state officials are holding with Medicaid providers. The 9 a.m. calls are scheduled to continue through at least the end of the month.
He said he also planned to report his activities to the Legislature.
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