Kansas’ largest disability advocacy group urged Gov. Sam Brownback and legislators Thursday to stop citing waiting lists for disability services as a reason to refuse Medicaid expansion.
The Big Tent Coalition, which represents Kansans with all types of disabilities, said the argument is disingenuous and is being used “as a method of evading sincere debate on the merits of a customized KanCare expansion plan.”
For a year Brownback’s administration has said the state should not accept Medicaid expansion under the Affordable Care Act while the waiting lists exist — one Brownback staffer sent a mass email saying it would be “morally reprehensible” to do so.
But Rocky Nichols, executive director of the Topeka-based Disability Rights Center, said the budget the governor proposed last week proves that’s empty rhetoric.
The proposal cuts money from Medicaid services for Kansans who are frail and elderly or have physical or developmental disabilities, he said.
“You can’t say we won’t expand Medicaid unless and until we eliminate the waiting lists … at the same time that you’re actually cutting funding for HCBS (home and community-based services),” Nichols said. “If that’s important to you, then you need to do what? You need to put your money where your mouth is.”
The governor’s spokeswoman, Eileen Hawley, said funding is not being cut for the disability services that have waiting lists.
The governor’s budget, on page 84, proposes to increase funding for physical disability services by almost $2 million in the current fiscal year but then decrease it by about $1.6 million in the fiscal year that begins in July. Developmental disability services would get a $1.2 million decrease in the current fiscal year and a $500,000 increase in the next.
The changes represent less than 2 percent of the total budgets for the programs.
Hawley said the differences are a function of transfers between the medical programs of the waiver populations and their support programs, but the total money remains the same.
“We have not cut, nor are we considering a cut to, HCBS,” Hawley said.
Medicaid in Kansas, known as KanCare, provides coverage for medical care mainly for people with disabilities and lower-income children and pregnant women. The waiting lists are for Medicaid waiver services that provide supports for Kansans with disabilities who already may be receiving their medical care through Medicaid.
Medicaid expansion under the Affordable Care Act would extend coverage to an estimated 150,000 low-income Kansans.
Nichols said telling Kansans they must choose one or the other is a “false narrative.”
“We can walk and chew gum at the same time, and we expect Kansas policymakers to do the same.”- Rocky Nichols, executive director of the Topeka-based Disability Rights Center
Medicaid expansion is fully federally funded until next year. Then the federal share begins gradually decreasing to 90 percent, although President Barack Obama has proposed an extension of the full funding for states such as Kansas that haven’t yet expanded Medicaid.
Nichols said expanding Medicaid could help make the waiver services more accessible by improving the job market for direct care workers and personal attendants. He said ending the waiting lists has long been the coalition’s main goal, but the group also advocates Medicaid expansion.
“We can walk and chew gum at the same time, and we expect Kansas policymakers to do the same,” Nichols said.
He contrasted Brownback’s proposed budget with that of Missouri Gov. Jay Nixon, who Nichols said proposed sinking an extra $131 million into that state’s waiting list for developmental disability support services.
Nichols said the Missouri proposal received bipartisan support, with one Republican committee chairman even suggesting $131 million was not enough.
The waiting lists have existed in Kansas throughout several administrations. Mike Oxford, executive director of the Topeka Independent Living Center, said the Big Tent Coalition protested their growth under Republican Gov. Bill Graves and Democratic Gov. Kathleen Sebelius.
Brownback’s administration used savings from the switch to Medicaid managed care under KanCare to reduce the lists when KanCare first rolled out. But Oxford said the governor has lately fallen short on that promise, which is written into the KanCare contract Kansas signed with federal officials.