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On January 1, 2017, the KHI News Service became part of KCUR public radio’s new initiative, the Kansas News Service. The Kansas News Service will continue to cover health policy news and broaden its scope to include education and politics. All stories produced by the former KHI News Service are archived here. Stories and photos may be republished at no cost with proper attribution and a link back to KHI.org.

State officials: Combining Medicaid waivers not about money

Cabinet members say better care and outcomes first priority, but savings may come

By Andy Marso | August 25, 2015

State officials: Combining Medicaid waivers not about money
Photo by Andy Marso Tuesday was the first stop on a listening tour on proposed changes to Medicaid waivers for people with seven categories of disabilities. Officials who participated in the event at the Capitol Plaza Hotel included, from left, Mike Randol, director of the division of health care finance at KDHE; KDHE Secretary Susan Mosier; and Kevin Bomhoff, director of strategic development at Wichita State University’s Center for Community Support and Research.

Cabinet officials say Kansas’ quest to combine Medicaid waivers for people with seven categories of disabilities is intended to provide better care and outcomes, not cost savings.

But costs will go down if care improves as intended, they say.

Officials from the Kansas Department of Health and Environment and the Kansas Department for Aging and Disability Services are beginning a statewide listening tour on the proposed changes after briefing a legislative committee on them Friday.

“What we want to be able to do with waiver integration … is really look at always providing services around the individual and the individual’s needs and not be specifically tied to limitations or restricted by limitations that may be in the individual waivers,” KDADS Secretary Kari Bruffett on Friday told the Robert G. (Bob) Bethell Joint Committee on Home and Community Based Services and KanCare Oversight.

Susan Mosier, the secretary of KDHE, stated similar goals to a group of about 75 people who showed up Tuesday for the first stop on the listening tour, the Capitol Plaza Hotel in Topeka.

Mosier said it was time to ditch “disability-defined boxes” in favor of home and community-based services tailored to each individual Kansan, no matter their disability or disabilities.

“Services should be based on a personalized plan of care and centered on an individual’s needs,” Mosier said.

The waiver services are intended to give Kansans with disabilities the support they need to live in their homes and communities rather than institutions.

Waivers services are divided into seven groups: autism, frail/elderly, intellectual/developmental disability, physical disability, serious emotional disturbance, technology-assisted and traumatic brain injury. All offer different types of support services and different limitations on the amount of those services, though there is frequently overlap among the waivers.

The state’s integration plan would merge those seven categories into two pools of services: one for children and one for adults.

After gathering feedback at more than a dozen meetings on the listening tour, state officials plan to post the details of the proposed change Sept. 30. Then there will be a formal public comment period on the proposal through November.

The final language is to be submitted to the federal Centers for Medicare and Medicaid Services on Jan. 4, 2016. Stakeholders then would have another opportunity to deliver public comments directly to federal CMS officials reviewing the proposal.

The changes would go into effect July 1, 2016, pending CMS approval.

‘Cautiously optimistic’

Advocates for people with disabilities on Medicaid have encouraged them to speak up with concerns about changes to their services.

But the people who attended the first listening tour meeting Tuesday were mostly service providers.

One of them was Jamie Price, chief operating officer of Community Living Opportunities, a Lawrence nonprofit that serves people with intellectual or developmental disabilities.

Price said she was “cautiously optimistic” about the waiver integration plan but emphasized that state officials need input from Kansans with disabilities to ensure they “develop the right system that makes sense and affects people positively.”

“I certainly think it brings promises for the beneficiaries to get more fluid, correct services at the right time from the right service provider,” Price said. “It’s a little early to totally understand all the pros and cons.”

Becky Ross, director of Medicaid initiatives for KDHE, told Price and the rest of the audience that the proposed changes were not tied to the state’s ongoing budget problems.

She said combining the waivers was something state officials had intended to do since moving Medicaid to a privatized managed care system called KanCare in 2013.

“This is just something we wanted to do, and now is the right time to do it,” Ross said. “We do believe waiver integration will allow us to save some money and maybe offer services to more people.”

Ross said Medicaid beneficiaries will not lose services in the switch and indeed may gain services that currently fall under a waiver separate from the one tied to their specific disability.

Reduced waiting lists

Ross, Mosier and Bruffett all said that cost savings from combining the waivers ultimately could allow the state to offer services to more people and eliminate waiting lists that some Kansans — particularly those with intellectual disabilities — remain on for years.

The timeline for seeing any cost savings from the change is murky.

“We do believe waiver integration will allow us to save some money and maybe offer services to more people.”

- Becky Ross, director of Medicaid initiatives for KDHE

During Friday’s hearing, Sen. Laura Kelly, a Topeka Democrat, asked Bruffett where savings would come from if the state serves the same number of people and offers new services to some of them.

“I’m having a hard time figuring out how you’re going to save money,” she said. “The integration actually sounds like it could be a good idea, but I don’t understand how you’re going to save money if you’re going to be providing all of the services to more people.”

Bruffett said it was “certainly a challenge,” but said savings could be seen in the long-term through better coordination of care.

“It is not put forth as a proposal in order to reduce costs,” she said. “It’s actually put forth as a proposal to improve outcomes, which from the beginning of KanCare is how we’ve said we’ll actually reduce costs in time.”

Bruffett said some short-term savings could result from shifting people from more expensive support services to more affordable services they previously weren’t eligibile for but are a better fit for their needs.

Mosier said Tuesday that in addition to allowing the KanCare companies to provide better-fitting services, the waiver change also would reduce duplicative paperwork and allow for a more seamless transition when KanCare members go from one waiver to another.

“We think this approach will result in some efficiencies and some savings that will help us to reduce or eliminate the waiting list,” Mosier said.