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Brownback administration sends mixed messages on waiver integration

Legislators, agencies differ on start date for Medicaid services change

By Andy Marso | April 01, 2016

Brownback administration sends mixed messages on waiver integration
Photo by Andy Marso/KHI News Service Members of the KanCare Advisory Council met Thursday in Topeka. From left are Larry Martin of Valley Falls, who represents elderly Kansans; Mike Randol, director of the Division of Health Care Finance within the Kansas Department of Health and Environment; and Tim Keck, interim secretary of the Kansas Department for Aging and Disability Services.

High-ranking officials in Gov. Sam Brownback’s administration are sending mixed signals to legislators on the timeline for implementing a major change in the way Kansans with disabilities receive services.

A legislative subcommittee has recommended postponing the change, known as waiver integration, one year to Jan. 1, 2018. Before leaving for a monthlong break, subcommittee members said they believed the administration would agree to that timeline.

But Thursday, during a KanCare Advisory Council meeting in Topeka, two of the highest-ranking officials from the agencies that will implement the integration said they still plan to do so on Jan. 1, 2017.

“I know there have been some discussions and activities across the street at the Legislature with respect to the waiver integration,” said Mike Randol, director of the Division of Health Care Finance within the Kansas Department of Health and Environment. “We again continue to evaluate all of our options, but at this point, from my perspective, we continue to move toward that 1-1-2017 date.”

Tim Keck, interim secretary of the Kansas Department for Aging and Disability Services, agreed.

“Mike’s right on target with what he said so far,” Keck said. “I think we need to move forward as though it’s going to be 1-1-17.”

That was not welcome news for legislators on the subcommittee who recommended the integration plan be postponed.

“That’s the first I’ve heard of it,” said Rep. Willie Dove, who chaired the subcommittee. “I’m not happy to hear that.”

Dove, a Republican from Bonner Springs, said he wanted to hear from the administration personally before he commented more.

Two other members of the subcommittee, Rep. Les Osterman and Rep. Jim Ward, said the chairman of the House Health and Human Services Committee, Rep. Dan Hawkins, had told them that the Brownback administration had agreed on the delayed 2018 implementation timeline.

Hawkins, a Wichita Republican, said Thursday afternoon that he had spoken with Lt. Gov. Jeff Colyer that same day and Colyer had told him there were no plans to move forward on 2017 implementation unless the administration cleared it with Hawkins’ committee.

Hawkins said Randol and Keck “could be out of step” with the rest of the administration.

“I don’t know what Randol and the others said, but I do know what the lieutenant governor’s office said,” Hawkins said.

The governor's spokesperson, Eileen Hawley, released the following statement Friday evening:

“The administration shares and appreciates the concern Chairman Hawkins and the House Health and Human Services Committee have about implementation of waiver integration," Hawley said via email. "It is important to the Legislature and the administration that our most vulnerable citizens be treated with great care and not be harmed with premature implementation. Dr. Colyer and Chairman Hawkins plan to speak further about waiver integration and KanCare 2.0. While no date for implementation of waiver integration has been set by the administration, internal planning continues as we strive to best serve the people of Kansas.”

Disability groups want more details

The waiver integration plan, which has been delayed once, is a major issue for all disability groups in Kansas.

The waivers provide Medicaid coverage for support services that allow Kansans with disabilities to remain in home and community-based settings rather than institutions.

The services are split into seven groups based on type of disability: developmental, physical, frail elderly, autism, traumatic brain injury, technology assisted and serious emotional disturbance. The Brownback administration’s plan would compress the services into two groups: one for children and one for adults.

Administration officials say that would allow all Kansans to receive a broader array of services more efficiently, rather than being constrained by labels.

But legislators and disability advocates say the plan is short on details and worry it could lead to service reductions.

KanCare Advisory Council members reiterated those concerns Thursday to Keck and Randol.

“Why push forward?” asked Allen Schmidt, a former state senator.

Randol said he knew disability advocates had concerns, and that was one reason the administration already postponed the integration once.

But he disputed the assertion that the administration had not provided enough details about the plan, citing many meetings with Waiver Integration Stakeholder Engagement, or WISE, groups.

“I think we’ve provided information at this point, and we’ll continue to move forward,” Randol said.

Downsides to delay

Other members of the advisory council, like Beth Simpson and Mark Hinde, said they had been part of some WISE meetings and there were stakeholders within those groups who, like Dove’s subcommittee, said they had not yet seen enough details about how the state plans to parse and deliver services post-integration.

Simpson, vice president of a long-term care pharmacy company, asked if the administration might delay the integration six months to coincide with the change in the fiscal year.

Hinde, president and CEO of a group that provides developmental disability services in southeast Kansas, asked if there was a date by which the administration would be unable to stop the integration process, even if it decided that the concerns of the stakeholders were justified.

“There’s still some angst … that we’re not going to be ready for it,” Hinde said.

Keck said the administration would continue to listen, but there are downsides to delaying the integration.

“There’s still some angst … that we’re not going to be ready for it.”

- Mark Hinde, president and CEO of a group that provides developmental disability services in southeast Kansas

He noted that two of the seven waivers — those for physical disability services and developmental disability services — currently have waiting lists.

“(Sometimes) somebody gets in the wrong waiver line, and if we integrate them we won’t have a line,” Keck said. “It’s easier to sort them out. That sounds terrible, but it’s easier to provide services, and that’s really what we’re trying to do.”

Randol and Keck both said they expect to hear from legislators about the integration timeline when the Legislature reconvenes in late April for the veto session.

Osterman said he would be at the front of the line.

“Oh yeah, they’re going to hear about it, and I’m going to do everything I can to stop it,” he said.

Ward noted that the health committee still has a bill in play, House Bill 2682, that would prohibit the administration from combining the waivers without legislative approval.