Gov. Sam Brownback's plan to include services for the developmentally disabled in upcoming Medicaid managed care contracts drew rebuke Thursday from spokesmen for disability groups and parents who said the administration's KanCare proposal was untried and moving too quickly. They urged legislators to intervene.
"Legislators should be asking tough questions," said Rocky Nichols, executive director of the Disability Rights Center, speaking on behalf of the Big Tent Coalition before the Senate Public Health and Welfare Committee as it held a fifth day of hearings on KanCare.
Administration officials on Nov. 8 announced they intended to privatize the Kansas Medicaid program, expanding managed care to include services for the elderly, disabled and the mentally ill. Two managed care companies already provide Medicaid-financed health services through the Kansas HealthWave program, which covers children and pregnant women from low-income families.
The governor's proposal calls for an "all-in" approach to Medicaid managed care with full implementation statewide starting Jan. 1, 2013. Officials say they plan to divide the work evenly among three companies. Kansas Medicaid serves about 350,000 people a year at an annual cost of about $2.8 billion.
Many states use managed care companies in their Medicaid programs, but only a handful have included services for the developmentally disabled in their contracts and none of them did it the way or as quickly as the Brownback administration proposes.
"Why rush?" Nichols asked the committee members. "Other states have taken their time."
Nichols and others also said that the states that had included day-to-day services for the developmentally disabled in managed care plans had eliminated waiting lists. The Brownback plan, they said, doesn't address the problem of more than 4,800 developmentally disabled Kansans waiting for services.
Tim Wood, campaign manager for the End the Wait Campaign, said the KanCare plan was premised on the "hat trick" goals of achieving "lower costs, better access and improved outcomes."
But, he said, "there is a serious lack of empirical data that indicates that this type of shift in care delivery actually works for states and beneficiaries."
Wood was among those who asked legislators to take action to "carve out" or exclude services for the developmentally disabled from the governor's plan.
Committee members also heard from Kathy Lobb, a developmentally disabled woman who is the legislative liaison for the Self-Advocate Coalition of Kansas.
"Before you approve of this drastic change," she said, "I hope that you will ask and will be able to answer many important questions about handing our second largest state budget item to out-of-state, for-profit companies."
Gayle Richardson of Overland Park, mother of a developmentally disabled person called the KanCare plan, "a change looking for a reason."
She said the current system works for her family and others and the proposed system would "add another layer between the parents of those who make decisions for our vulnerable kids. We have all experienced the frustration of dealing with insurance companies who have denied medical care, restricted medications and obliged us to use a doctor on their list. The new proposal goes way beyond insurance companies making medical decisions. Now, they will be making decisions on our kid's day-to-day care. They do not have experience in this area."
The governor's plan got a friendlier reception earlier in the day when Lt. Gov. Jeff Colyer described it to members of the House Appropriations Committee.
Colyer gave a broad brush description of the plan but spoke briefly about why the administration thought it important to include services for the developmentally disabled.
"The (Medicaid) program is extremely fragmented," he said. "There are multiple silos. No one has responsibility for the individual."
Colyer, a plastic surgeon, gave as an example a recent surgery he performed on a developmentally disabled person. He told committee members that the patient was ready to leave the hospital on a Friday but was kept needlessly until Monday because the patient's daily care provider didn't act quicker.
He also said KanCare would work to improve the "independence" of disabled or elderly persons.
"We want to preserve independence and create a path to independence," he said. "We want people to be able to live the full American dream."