Gov. Sam Brownback's plan to remake the state Medicaid program got a chilly reception Monday at the first of two scheduled public forums on KanCare.
There were nearly two hours of comments and questions from a crowd of more than 200 people gathered at a Wichita State University auditorium. Most of the 40 comments were negative.
Those who spoke were officially capped at three minutes each, though many went much longer. Most comments came from relatives of the elderly, disabled and mentally ill or from medical providers who cater to those groups.
They would be the groups most affected by the administration's KanCare plan, which aims to expand fixed-cost managed care to include virtually all the 380,000 Kansans currently on Medicaid.
The comments mostly touched on one or more common concerns:
- The timeline to implement the plan in January is too fast.
- Patients may not be able to receive care from their existing providers under the plan.
- Managed care will result in loss of services.
Some people also expressed worries that the Brownback administration is setting up Kansas for problems experienced by other states under managed care.
Commenter Richard Harris said attempts to reform Medicaid have been based on "soft science and limited evidence."
"The concerns I have boil down to the evidence. Most managed care operations cut services and do not significantly cut expenses," he said. "I challenge the governor and lieutenant governor to name for us any state in which the system you are proposing has worked and has provided a higher level of service across the board at a lower cost to the state."
For the most part, comments and questions were accepted without direct answers from the Brownback administration. Officials present included Dr. Robert Moser, secretary of the Kansas Department of Health and Environment, the agency that administers Medicaid through its Division of Health Care Finance; Health Care Finance Director Kari Bruffett; Kansas Department on Aging Secretary Shawn Sullivan; and Gary Haulmark, deputy secretary at the Kansas Department of Social and Rehabilitation Services. At least three legislators also attended: Sen. Dick Kelsey, a Goddard Republican; Sen. Oletha Faust-Goudeau, a Wichita Democrat, and Rep. Steve Alford, a Ulysses Republican.
During two 15-minute presentations before the comment period, Moser and Sullivan attempted to address common concerns they said they already had heard. Sullivan said the alternative to KanCare was not the status quo.<a name="continued"></a>
KPR story: KanCare hearing draws extensive criticism
'Huge cuts looming'
"The alternatives to the changes we're making are continued cost increases, the risk of reimbursement rates to providers that threaten the quality of care provided, (and) huge cuts for Medicaid that are looming at the federal level probably to the tune of hundreds of millions of dollars," he said.
"The one thing we are not doing that often gets reported ... is that we're turning this Medicaid system over to private contractors. That's not our intent at all. We already have 73 percent of those we serve in Medicaid on a managed care-type system," Sullivan said.
"We have not turned over the contracting of Medicaid to those vendors to just do whatever they want. We have extremely stringent performance standards, pay-for-performance measures. There will be very distinct outcome and accountability measures that the state will build into this. This will be a partnership between the state and vendors."
After the forum, Moser told KHI News Service that he was pleased with the turnout and the opportunity to share "a different way of thinking about how to provide care" — that would focus on quality of care rather than how many times a patient was seen.
"We hear a lot of the same concerns and some misunderstandings. It still makes a lot of folks nervous about contracting with private companies," Moser said. "But we're already contracting with private companies in Kansas Medicaid, so this really isn't anything new. To bring the resources in to make this work — from care coordinators to a robust network of providers — we can't afford to build that ourselves, but we can contract with these partners that have that experience and deliver the model much faster."
Brownback officials have said they intend to resubmit a waiver application in July to federal officials seeking the flexibility they want to remake the state Medicaid program.
At least two public meetings, like Monday's, are required by new federal transparency rules as part of the waiver application process. The second KanCare public forum is set for 3 p.m. Wednesday at Memorial Hall Auditorium in Topeka (map).
Brownback officials need the so-called Section 1115 Medicaid waiver approved in order to move forward with their plan to shift the state's Medicaid beneficiaries into managed care plans operated by three insurance companies.
Kansas officials submitted their initial application on April 26, the day before new public input requirements for 1115 waiver applications became effective.
But on June 5 the administration asked the federal Centers for Medicare and Medicaid Services to withdraw the application, pending additional input from two Indian Health Service centers.
Brownback officials have said they are still on track to launch KanCare on Jan. 1. The administration is negotiating with five insurance companies that have submitted bids for KanCare contracts, each of which is expected to be worth about $800 million.
Kansas Medicaid costs about $2.8 billion a year, 60 percent of which is funded by the federal government with the state paying the rest.
The governor has said his plan will save about $850 million over five years and improve services for Medicaid patients.
Highlights from the public comments fielded Monday included:
• Russ Pataky, Wichita: "How are we going to be saving money when we're going to be paying exorbitant CEO salaries, the fat cats at the top, and a bunch of stockholders? And add that to the $838 million that you're taking away, and I can't even guess how much is going to be taken from the people who need services."
• Celia Chase, who receives care through Medicaid home- and community-based services: "You've already cut most of our benefits — what are we supposed to do? ... Some of the people where I live think the government just wants to kill us off. Get rid of us. They literally think that."
• Ron Kelly, board member of the Training and Evaluation Center of Hutchinson, a Community Developmental Disability Organization, or CDDO, that provides services to the developmentally disabled: "In Kentucky they talked a lot about the slowness of reimbursements. ... If we were to get into the 90-day reimbursements that they're talking about in Kentucky, it would be a total financial disaster for us. I would also ask why you haven't looked into being self-insured and using these insurance companies as administrators rather than as risk insurance companies. ... If private companies think they can save money doing that, then I think the state should look at it as well. I feel strongly that a legislative oversight committee should be established prior to implementation. ... I would also ask what is the Kansas plan to address the waiting list for physical or developmental disabilities. Addressing that waiting list should be a part of this change."
• Regan Marshall, Wichita: "What are (managed care companies) in business for? They are there to make a profit. Who are they going to make the profit from? Us, right? What incentive do they have to provide the same level of care that we're getting today? Their incentive is profit. ... In my job, we work with insurance companies and third-party administrators. What I have experienced from a financial side is slow payments or slow reimbursements. If you consider the millions of dollars that these organizations will be receiving from the state of Kansas, just imagine if left unchecked the substantial interest income by slowing down these reimbursements. They can increase their profits by doing absolutely nothing ... that's exactly what's going on in Kentucky. ... If payment delays begin, what recourse do caregivers have?"
• Rich Giblin, home- and community-based services administrator in Wichita: "I think the administration has their heart in the right place. They want to make this work. But I'm also concerned when the next administration comes along. It takes an extreme amount of state administration to stay on top of these managed care organizations. If you let off for a year or four, things go downhill for those that need these services."
Administration officials said written comments on the KanCare proposal should be sent to KanCare@kdheks.gov by July 14.
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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