Kansas officials today announced they have asked that the so-called 1115 Medicaid waiver application they submitted to federal authorities in April be withdrawn pending consultation with two Native American health centers.
The Governor's Office issued a statement today saying the administration intends to resubmit the waiver application in July. The statement included a copy of the email sent by Kari Bruffett, director of the state's Health Care Finance Division, to Victoria Wachino of the Centers for Medicare & Medicaid Services, notifying the federal agency of the state's intentions. Wachino is director of the CMS division that oversees state waivers and demonstration projects.
Bruffett told Wachino that because of the state's "commitment to thorough consultation" with tribal medical providers, "we have concluded that further consultation regarding KanCare is appropriate. At the same time, we will also provide for broader public comment consistent with the transparency process established in the CMS regulations that became effective April 27, 2012."
Email to CMS
Kansas officials submitted their initial application on April 26, the day before new public input requirements for 1115 waiver applications became effective. The rules require that states hold at least two public meetings on a waiver application before submitting it and allow public comment for at least 30 days prior to the submission. CMS then has 15 days to notify state officials if the application was complete and then also allows 30 days for the public to comment to federal officials about the plan. Scores of comments about the initial KanCare waiver application already have been posted to the CMS website.
KanCare is the name that the administration of Gov. Sam Brownback has given its Medicaid reform proposal.
If enacted, the plan would move virtually all of the state's 380,000 Medicaid beneficiaries into fixed-cost managed care plans overseen by three for-profit insurance companies.
State officials said they had failed to notify Haskell Health Center in Lawrence and the White Cloud Health Station prior to submitting the waiver application. Brownback officials did meet Feb. 22 with representatives of the state's four tribes to discuss KanCare.
Miranda Steele, a spokesperson for the Kansas Department of Health and Environment — home to the state's Division of Health Care Finance, which oversees state Medicaid finances — said CMS had not red-flagged any other issues in its review of the state's initial waiver application.
"We discussed with them (CMS) the IHS issue and are submitting a new application to ensure we’re meeting all the requirements," Steele wrote in an email to KHI News Service.
New HHS 1115 waiver rules
Brownback officials also said they believed they could still meet the Jan. 1 deadline they have set for launching KanCare, despite the new public comment periods.
"The plan remains to announce the three companies this summer when negotiations are completed and we can execute the work leading to a Jan. 1 implementation. So, the only thing on our timeline that’s changed is the addition of public meetings mentioned in the news release today and the application we’ll submit subsequent to the additional tribal consultation," Steele said.
State procurement officials continue to negotiate with the five managed care companies that submitted bids on the KanCare contract proposal. The state's $2.8 billion Medicaid program essentially would be equally divided among three winning companies. According to an earlier timetable released by the administration, contracts with the three finalists are to be signed and approved by July.
News that the public comment period for KanCare was being extended was welcome to some of the plan's most active opponents.
"We're glad that (public comment) period is being extended," said Tom Laing, executive director of InterHab, an association that represents most of the state's Community Development Disability Organizations, or CDDOs. "We hope it is extended in a vigorous and transparent way."
Laing said a number of questions remain about how KanCare would work, including the enrollment process for beneficiaries.
"We have a number of concerns," he said.
InterHab member organizations and families of the developmentally disabled have said that private insurance companies are not well-suited to managing the long-term services needed by most developmentally disabled Medicaid clients. They also have said that the public forums the administration held last summer didn't allow for adequate public comment on KanCare because the administration didn't unveil the details of the plan until well after the meetings.
Steele said the dates of the public meetings were still undetermined but would be published sometime next week in the Kansas Register.
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