Details of various suggestions for improving the Kansas Medicaid program were made public this week.
They ranged from the complicated, such as shifting the blind, disabled and elderly into managed-care programs or capping Medicaid payments, to the relatively straightforward - such as ending Medicaid payments for routine circumcisions. The full list of suggestions is available here.
Also, a consortium of the state's health foundations has agreed to underwrite the process for soliciting public input about the Brownback administration's developing Medicaid makeover plan. Kansas Grantmakers in Health has agreed to provide $125,000 for the effort. State officials said they planned to use the money to hire a consultant to assist in designing and implementing the, "inclusive public input and stakeholder consultation process."
Sebelius letter to Brownback
The grantmakers group includes the Kansas Health Foundation, the REACH Foundation, the Sunflower Foundation, the Health Care Foundation of Greater Kansas City and the United Methodist Health Ministry Fund.
On a related front, the governor this week traded letters again with U.S. Health and Human Services Secretary Kathleen Sebelius as part of a continuing push for more state flexibility in the spending of federal Medicaid dollars.
The ideas for changing Medicaid were solicited by Lt. Gov. Jeff Colyer, who has been tasked by the governor with leading the Medicaid program's redesign. Colyer seeks savings of between $200 million and $400 million that can begin in fiscal 2013.
The suggestions and proposals submitted - there were about 120 - ranged from big to small. Some were from average citizens, but more were from advocacy groups or major corporations.
There were jargon-laced, multi-page proposals, including one to expand managed-care to the blind, elderly and disabled, which could be a significant and complicated undertaking. But some ideas were quite concise and straightforward.
"The alleged benefits of circumcision do not outweigh the known risks...Scarce Medicaid dollars should be spent on necessary and vital medical needs," wrote Travis L.C. Wisdom of the National Organization of Circumcision Information Resource Centers in Henderson, Nev.
Wisdom said unneeded circumcisions and resulting complications cost taxpayers nationally more than $70 million a year.
Some of the proposals claimed potential savings of hundreds of millions of dollars over time. Others would require more state spending. Most weren't specific about potential savings or costs.
Cerner Corporation, a major health technology company based in Kansas City, proposed a multi-pronged approach built on the mining of health data and the targeting of high-cost Medicaid beneficiaries for intensive case management. The company's proposal also called for expanding health information technology across the state and the use of "e-visits" in rural areas.
Brownback letter to Sebelius
United Health Care, a managed care company with operations in 26 states, suggested moving the blind, elderly and disabled into managed care. The company said that in Kansas, 46 percent of long-term care is provided in nursing homes. If that percentage were reduced to 33 percent, the state could save $250 million over 10 years.
Six different proposals came from the University of Kansas, among them one that would work with obese Medicaid beneficiaries to encourage weight loss.
One proposal was very brief and on its face seemed abundant in common sense, though probably not simple to implement.
It came from Cindy Lane, financial officer for the Southeast Kansas Area Agency on Aging in Chanute.
In a single paragraph, Lane suggested the state stop paying for home and community based services for a frail senior once that begins to cost more than nursing home care.
Generally, home services cost Medicaid significantly less than nursing home care, but apparently there are instances when that is not the case.
"Is it really in the best interest of the state to continue this policy," Lane asked.
A proposal from Vivius called for implementing the company's "Personalized Health Care System." The plan had many elements similar to reforms proposed by Colyer when he was a member of the Kansas House. It would limit what Medicaid would contribute toward a beneficiary's care and create a premium schedule. It would not be possible under current federal regulations.
The Brownback administration since taking office in January has been pushing the U.S. Department of Health and Human Services to give Kansas more flexibility in the way it can use federal Medicaid dollars.
The governor has traded a series of letters with HHS Secretary Kathleen Sebelius, asking for several things ranging from a federal Medicaid block grant to an exemption from the federal requirement that state's maintain Medicaid services and eligibility standards equal to those in place when the Affordable Care Act was signed into law about a year ago, or face the possibility of having to pay back millions of dollars in federal aid.
The latest letter exchange was this week.
Sebelius, in a March 30 letter, responded to an earlier Brownback request seeking exemption from the so-called "maintenance-of-effort" requirement.
"Optional Medicaid coverage in Kansas is quite limited, and it is provided mostly to very frail and disabled children and adults," Sebelius wrote, "so it would help HHS to know which groups of Kansans you seek to drop from coverage under an MOE waiver."
Brownback replied with an April 7 letter.
"The challenges we face now demand a different level of flexibility to ensure Kansas does not end up in a position of other states that are being forced to drop beneficiaries," he wrote. "Unfortunately, Medicaid's current structure and the long approval process does not allow states to innovate at the pace our rapidly changing economies and health care systems demand."