Throughout the 2019 Kansas legislative session, Kansas Health Institute (KHI) staff will prepare a weekly summary of the highlights, with a specific focus on health policy related issues. Sign up here to receive these summaries and more, and also follow KHI on Facebook, Twitter and LinkedIn. Previous editions of Health at the Capitol can be found on our archive page.
Week 8 of the 2019 Session
After Turnaround Day last Thursday, legislators returned to work on Wednesday, March 6, for a short week.
On March 7, Gov. Laura Kelly provided opening comments for an event in the Capitol, hosted by Chamber of Commerce officials from several communities, titled The Economics of Expansion — Moving Kansas Forward, which focused on how expansion of KanCare could stimulate economic growth in the state. The featured speaker for the event was Sarah Collins, Ph.D., of the Commonwealth Fund, who spoke about how federal funding and increased health coverage can provide economic benefit to a state, including job creation, increased state tax revenue, improved access to health care and the use of federal dollars to replace state spending on current programs.
On March 8, Gov. Kelly signed Senate Bill (SB) 9, the $115 million appropriation to repay money owed to the Kansas Public Employee Retirement System (KPERS) that was passed unanimously by the House and Senate. The House also passed a $200 million-plus tax cut, which included an amendment for decreasing the sales tax on food. The tax cut bill will head to conference committee or the Senate may elect to concur with the bill as amended by the House.
House Health and Human Services Committee
(Rep. Brenda Landwehr, Chair)
On March 6-8, the committee hosted a roundtable discussion on Medicaid expansion, featuring 15 participants representing numerous proponent and opponent organizations. On March 6, the discussion began with a presentation by Kari Bruffett, Vice President for Policy at the Kansas Health Institute (KHI), who provided an overview of updated estimates of enrollment and costs associated with Medicaid expansion that were released by KHI on March 5. Chair Landwehr then opened the discussion and asked participants to begin by talking about the goals of Medicaid expansion.
Proponents indicated that expansion would close the current coverage gap, improve patient outcomes, retain providers, boost the economy in Kansas and allow providers who currently serve the uninsured to expand the services they offer. Opponents said expansion would divert resources from vulnerable populations toward able-bodied individuals, increase the federal deficit and decrease the control Kansas would have over its Medicaid program. They also expressed concern that evidence of improved health outcomes due to expansion is inconclusive. Participants also discussed whether there are other options (e.g., direct primary care, use of mid-level providers, new or alternative insurance products) the state could pursue in lieu of or in conjunction with expansion.
On March 7, the committee continued the roundtable discussion with a focus on the need for data showing the health effects of expansion. Participants discussed the link between coverage and health outcomes as well as the resulting health effects in states that already have expanded Medicaid. The KanCare Meaningful Measures Collaborative, which brings together numerous stakeholders in the Medicaid program and focuses on the compilation of KanCare data, was suggested as a resource for decision-makers.
On March 8, the committee wrapped up the discussion on Medicaid expansion with a focus on how the state portion of expansion would be funded, estimated to be about $50 million a year. Participants also discussed the impact of Medicaid expansion on the financial condition of hospitals, especially those located in rural parts of the state, and the issue of uncompensated care currently being provided by hospitals and other health care providers in the state. Chair Landwehr noted that the cost of health care is not addressed by expansion.
Senate Public Health and Welfare Committee
(Sen. Gene Suellentrop, Chair)
Committee did not meet this week.
House Children and Seniors Committee
(Rep. Susan Concannon, Chair)
Committee did not meet this week.
House Social Services Budget Committee
(Rep. Will Carpenter, Chair)
On March 6, the committee made recommendations on the Kansas Department for Aging and Disability Services (KDADS) budget. Recommendations included adoption of the governor’s recommendations for Fiscal Year (FY) 2019 and FY 2020, plus:
- $12 million ($5 million state general funds [SGF]) to reduce the waitlists for intellectual and developmental disabilities services,
- $1.6 million SGF to cover the loss of federal match for individuals transitioning out of institutions,
- $13.4 million to provide a 2-percent increase in reimbursement for Medicaid home and community based (HCBS) waiver services,
- $4 million to increase psychiatric residential treatment facility funding (PRTF),
- $4 million SGF for grants in FY 2020,
- $154,000 SGF in FY 2019 and FY 2020 for patient assessment and placement programs,
- $4 million SGF in FY 2019 for clubhouses to account for lost revenue from lottery vending machines,
- $13.6 million for a 2-percent increase in reimbursement for nursing facilities in FY 2020,
- $500,000 and one full-time equivalent (FTE) employee for a housing pilot program in FY 2020,
- A technical fix for the governor’s recommendations regarding the loss of expected revenues from lottery vending machines, including $900,000 in FY 2019 for community crisis centers and $300,000 in FY 2019 and $2M in FY 2020 for clubhouse models,
- $850,000 SGF for medical detoxification services and $500,000 SGF for grants, and
- A note of concern about the home and community based services (HCBS), intellectual and developmental disability (IDD), and physical disability (PD) Medicaid waiver waitlists, with a recommendation that KDADS investigate options for decreases those waitlists. Chairman carpenter noted it would cost about $47M a year to eliminate those waitlists.
The committee then began its hearing for the Kansas Department of Health and Environment (KDHE) budget with an overview presentation, followed by Interim Secretary Lee Norman responding to questions about screenings for newborns and plans to bring the Medicaid application clearinghouse back under the agency.
On March 7, the committee continued its hearing on the budget for KDHE and received oral testimony from representatives of several organizations, including the Association of Community Mental Health Centers, Konza Community Health and Dental Center, Cerebral Palsy Research Foundation of Kansas, Community Care Network of Kansas (formerly the Kansas Association for the Medically Underserved), LeadingAge Kansas, Oral Health Kansas and the Kansas Mental Health Coalition, and written testimony from over a dozen additional groups. Most of the requests received through testimony focused on expanding KanCare, increasing Medicaid reimbursement rates for dental providers and funding for specific programs or organizations.
House Insurance Committee
(Rep. Jene Vickrey, Chair)
On March 6, the committee held a hearing on SB 32 (also known as the Farm Bureau bill), which would authorize the Kansas Farm Bureau to operate a health benefit plan that is not insurance and would be exempt from the jurisdiction of the Kansas Insurance Department. As stated during the hearing in the Senate Financial Institutions and Insurance Committee, Farm Bureau officials confirmed their intention to offer to members a plan that would not have to comply with the requirements of the Affordable Care Act and would require applicants to be individually underwritten for eligibility to participate in the plan and setting premium rates. Opponents of the bill, including representatives of patient advocacy organizations and health insurance companies, again expressed concerns about coverage for individuals with pre-existing health conditions and the potential loss of healthy individuals from the regulated insurance market. Committee members asked questions about the impact on the private insurance market of similar Farm Bureau plans operating in other states and expressed concerns about not having more specific details about the proposed Kansas Farm Bureau plan.
Senate Financial Institutions and Insurance Committee
(Sen. Rob Olson, Chair)
Committee did not work any health-related bills this week.
The Kansas Health Institute supports effective policymaking through nonpartisan research, education and engagement. KHI believes evidence-based information, objective analysis and civil dialogue enable policy leaders to be champions for a healthier Kansas. Established in 1995 with a multiyear grant from the Kansas Health Foundation, KHI is a nonprofit, nonpartisan educational organization based in Topeka.