After prodding from local consumer advocates and federal overseers, Kansas officials have made public more details about how they would implement KanCare and say they plan to release more information as quickly as it becomes available.
A federal decision on the state’s plan to remake its Medicaid program is expected any day and the new information is evidence of the back-and-forth in the discussion between the federal Centers for Medicare and Medicaid Services as the administration of Gov. Sam Brownback continues its push for a Jan. 1 launch of the new program.
Brownback officials so far have posted six section 1915c waiver amendments on the KanCare website and also within the last several days have posted six “implementation activities” reports that outline previously undisclosed details about how they expect KanCare to work.
"These are some very specific implementation reports we're submitting to CMS and making available to all of you simultaneously," said Kari Bruffett, director of the division of health care finance at the Kansas Department of Health and Environment, talking last week in a teleconference with Medicaid providers.
KanCare Implementation Reports
Among the things outlined in the reports:
• State officials intend to create an ombudsman position at the Kansas Department for Aging and Disability Services to field complaints and questions about KanCare from Medicaid enrollees and service providers. They began recruiting for the new position Nov. 12 and began interviews last week with the goal of having a person hired by Jan. 1.
• A timeline and plan for communicating the KanCare changes to Medicaid enrollees and providers.
• A plan for following up on “returned” mail, information sent to enrollees that fails to reach the intended recipient.
• Details of how eligibility and enrollment in KanCare will be verified.
• A plan for how the customer call centers will deal with the influx of expected queries from Medicaid enrollees. According to the report, 226 customer-service representatives are “ready to step in as needed.”
Some of the state’s recent actions seem to stem, at least in part, from CMS having heard concerns from some Kansas advocacy groups about the need for more information about KanCare and the creation of an ombudsman position.
Anna Lambertson, executive director of the Kansas Health Consumer Coalition, said she and other advocates met with CMS officials and followed up with a Nov. 13 letter to them outlining their concerns about KanCare. CMS responded 10 days later.<a name="continued"></a>
KHCC letter to CMS
CMS response to KHCC
Letter to CMS
“We asked for the state to be more transparent, posting more on line,” Lambertson said. “And we made some very specific requests of the state for an outreach education plan that meets the needs of the various populations and involves the stakeholders.”
Lambertson said she was still reviewing the documents posted subsequent to the group’s letter to CMS. But she said she already had seen enough of the ombudsman plan to know that it fell short of what the consumer groups were seeking.
“We feel very strongly there are certain things that really need to be in place in order for the state to be ready to kick off on Jan. 1, “ she said. “And I personally don’t feel those processes are in place.”
Lambertson said her group and others want an ombudsman's office that is independent of the state agencies directly involved in KanCare. She said that would assure the ombudsman is autonomous and able to freely pursue complaints that might involve the state Medicaid agencies.
And she said the state had not budged on the advocates’ request that KanCare be co-branded for a time with HealthWave, a move they believe would help ease confusion among enrollees during the changes.
“At this point our biggest concern is just to make sure that we don’t lose families in the transition,” said Shannon Cotsoradis, chief executive of Kansas Action for Children.
Advertising the transition
Using a grant from the Kansas Health Foundation, she said, KAC has been airing radio and television ads and also plans newspaper ads to help make HealthWave enrollees aware of the planned changes. Total budget for the campaign is $171,000, according to Christie Applehanz, KAC’s vice president of public affairs.
Cotsoradis said progress had been made in the last couple of years getting children enrolled in HealthWave and there was concern among advocates that the changes might keep many people eligible for the program from enrolling it.
She said an earlier study of people who were eligible but not enrolled in HealthWave showed that “one of the biggest barriers to getting people enrolled was the process itself.”
Miranda Steele, communications director for the Kansas Department of Health and Environment, said the agency has been working with the advocacy groups to help spread the word about planned program changes.
For example, she said she was informed Monday by the REACH Healthcare Foundation that KDHE, KAC, Lambertson’s group and the Kansas Association for the Medically Underserved would receive a $50,000 grant for radio and direct mail ads informing people about the KanCare changes.
“It’s to inform consumers about the transition from HealthWave to KanCare,” Steele said.
She said state officials did not want to “co-brand” the two programs, “because KanCare is a new program with new features.”
She praised the communication efforts undertaken by KAC.
“I think the radio and TV spots organized by Kansas Action for Children are terrific,” she said.
State officials also have been drawing attention to online provider directories posted on the websites of each of the KanCare managed care companies. And they have posted on the KanCare site a report showing that all three companies have at least one provider in each of their service networks in all or most of the state’s 105 counties. Steele said KDHE did not have a more precise count of how many providers each company has signed to its networks.
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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