Kansas will bring its privatized Medicaid program before federal officials for reauthorization this year, but with new requirements to better serve rural populations, the state’s top health official said.
Susan Mosier, secretary of the Kansas Department of Health and Environment, spoke to the House Children and Seniors Committee on Tuesday about Medicaid and the Children’s Health Insurance Program. In Kansas, three private managed care organizations administer Medicaid and CHIP through a waiver program known as KanCare.
KanCare is open to adults with certain disabilities or chronic conditions, the “frail elderly” and low-income children and pregnant women. Adults without those conditions are eligible only if they have a child and earn less than 38 percent of the federal poverty line, or about $6,050 annually for a family of two.
KDHE will develop a request for proposals to administer KanCare and submit it to the federal Centers for Medicare and Medicaid Services this fall, Mosier said. If CMS approves, KDHE will send the request for proposal for bids by the end of 2016, she said. The winning bidders would take over in January 2018.
“The expectation is we will be continuing the waiver,” she said.
The reauthorization proposal is likely to formalize pilot programs that use technology to reach people in areas of the state without easy access to specialist care, Mosier said.
For example, a “telementoring” program involves specialists at the University of Kansas Medical Center or elsewhere coaching primary doctors to provide care so patients don’t have to drive long distances, Mosier said. The idea could ease access to behavioral health care and diabetes treatment, which don’t have enough specialists in rural areas, she said.
“Right now it’s more pilot programs, but we may have more strict requirements,” she said.
KDHE also is looking into alternative payment structures, which would represent a shift away from the traditional fee-for-service model, Mosier said. Bundled payments would be one option, but the department will meet with stakeholders first to discuss ideas, she said.
“The people who are on the front lines need to be involved,” she said.
The goal of Medicaid waiver programs was to give states more flexibility to achieve the “triple aim” of improving individual care, improving the population’s overall health and lowering costs, Mosier said.
Most quality measures have shown improvements, Mosier said, though KDHE hasn’t seen better results in the percentage of children receiving an annual checkup and the percentage of people with substance abuse disorders participating in self-help programs. Measures related to diabetes control have improved, but Kansas still is in the bottom half compared to the other 49 states.
So far, the number of inpatient days and emergency room visits has decreased, Mosier said, while use of home and community-based services increased substantially.
“The utilization pattern is what we would expect with the goals of KanCare,” she said. “What you would expect to see is a decrease in inpatient days and emergency services.”
Costs have grown an average of 5.5 percent a year since KanCare was introduced in 2013, down from an average of 7.5 percent annual increases in previous years, Mosier said. The total costs, however, showed increases of 9 percent from 2013 to 2014 and 7.8 percent from 2014 to 2015.