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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 response was negative.
There were 40 comments — officially capped at three minutes each, though many went much longer. Most 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 was too fast Fear that patients' existing providers couldn't be kept under the plan That managed care would result in loss of services, Some people also expressed worries that the Brownback administration was setting up Kansas for problems experienced by other states under managed care.
'Soft science' 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 which administers Medicaid through its Health Care Finance division; 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.
'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."
As part of its effort to remake the Kansas Medicaid program, the administration of Gov. Sam Brownback has completed its 1115 Medicaid waiver application.
Lt. Gov. Jeff Colyer and other top administration officials fielded questions about it today during an hour-long Statehouse press conference.
The application was posted Thursday without fanfare to the website of the Kansas Department of Health and Environment and also submitted to the federal Centers for Medicare and Medicaid Services.
"We sincerely appreciate the accessibility and candidness of CMS throughout this application process," Colyer said.
The administration earlier this year gave federal officials a concept paper roughly outlining what would be in the full waiver application. Brownback officials need the waiver approved in order to move forward with their plan to shift the state's 350,000 Medicaid beneficiaries into managed care plans operated by three insurance companies.
The administration currently is reviewing bids from five companies. According to the timeline attached to the waiver application, administration officials intend to have the final three companies chosen by May with contracts signed by June. State officials said they expected CMS to approve the contracts sometime in August.
Town hall meetings to inform Medicaid clients and providers about how the plan would work are scheduled to begin in July.
The new program would be launched Jan. 1, 2013, assuming the federal approvals are secured and the managed care companies have been certified ready to go.
The waiver application included information about the administration's recent agreement to postpone until January 2014 the inclusion in KanCare of long-term services for the developmentally disabled.
The greatest opposition to the KanCare plan has been from families of the developmentally disabled and their service providers.
Had the administration not submitted its application by today, it would have been required to meet new federal regulations regarding public input on 1115 waiver applications.
Colyer said the application wasn't submitted to meet that deadline and that administration officials felt they met most of the new requirements anyway because of the various forums and public meetings they have attended or held while developing their Medicaid makeover plan.
The new requirements, effective today, would require that state officials hold at least two public hearings and allow comment on an application 30 days prior to submitting it for federal review.
Federal officials now will allow a 45-day public comment period before acting on the application.
Among those planning to comment to federal officials is Kansas Action for Children, a Topeka-based advocacy group.
Shannon Cotsoradis, the organization's chief executive, said KAC has several concerns about the KanCare plan, including the fact that it doesn't spell out how those currently enrolled in the state's HealthWave program will be moved into KanCare.
HealthWave provides medical services to low- and moderate-income children and pregnant women who are eligible for Medicaid or the Children's Health Insurance Program.
"We have 238,000 Kansas children that rely on HealthWave and there doesn't seem to be a clear and transparent process for transitioning them to KanCare," Cotsoradis said.
Under KanCare, Medicaid clients would be automatically assigned to one of the three managed care companies. The clients then would have 45 days to decide if they wanted to be enrolled with another company.
Cotsoradis said she feared the "auto assigning" of clients could disrupt relationships some children or families have developed with doctors or other Medicaid providers, if it turns out that the providers are in the network of a company other than the one to which the family has been auto assigned by the state.
She said many families likely wouldn't learn that they had been put in a new plan until they tried to go to the doctor and that might not happen within the 45 day window for choosing a different plan.
"So all that work that's been done over years to see that that kid has a medical home could be disrupted by the auto assignment," she said. "That can be a huge thing for those with special health care needs. Disruption in the relationship can be very problematic."
Administration officials have said they intend to auto assign equal thirds of the state's Medicaid population to each of the three managed care companies to assure that each company has enough clients to sustain a statewide operation. The KanCare plan requires that each of the companies provide services statewide, as opposed to operating in a specific region of the state or city. Officials have said that component of their plan is essential to assuring quality services in all parts of the state, including the more remote, rural counties.
Services for developmentally disabled wouldn't be included in KanCare until 2014.
House Majority Leader Arlen Siegfreid is preparing a budget proviso that would "carve out" until 2014 long-term services for the developmentally disabled from Gov. Sam Brownback's Medicaid makeover plan.
The proviso has been cleared with the Governor's Office, according to sources in the Legislature and the administration, which means it likely will move through the Legislature with little or no opposition.
A large number of legislators, including a majority in the Senate, already have signaled their desire to see the planned Jan. 1 launch of KanCare delayed until July 1, 2013. It is unlikely many will oppose delaying until 2014 what has been the most controversial part of the governor's plan.
It would be the first major change to the governor's KanCare proposal since it was announced in November. The inclusion of non-medical, long-term services for developmentally disabled Medicaid clients has produced the biggest opposition to the governor's plan at the Statehouse and in county seats across Kansas.
For example, Johnson County commissioners today joined their counterparts from more than 30 other counties in approving a resolution asking the governor to exclude the developmental disability services from the plan. Earlier this week, Jim Rice, chairman of the Seward County Commission, published an open letter in the Liberal newspaper taking the Brownback administration to task on the issue, comparing KanCare to Obamacare.
Word of the pending proviso traveled fast after Siegfreid discussed it with Rep. Bob Bethell, an Alden Republican who chairs the House Aging and Long-term Care Committee. Bethell said Siegfreid told him he could share the news with other legislators. Word spread from there.
County officials across Kansas are raising doubts about KanCare, Gov. Sam Brownback's plan for letting insurance companies manage the state's $2.8 billion Medicaid program.
"Before the administration gets to the point of signing contracts with these companies, it should let the Legislature, a special committee or the public know what's in them so we can have the professionals on the ground tell us where the potholes are. We shouldn't be putting our vulnerable populations at risk," said Ed Eilert, a Republican member of the Johnson County Commission and a former Overland Park mayor, a post he held 24 years.
Johnson County is Kansas' most heavily populated county. Eilert said he expected the commission there soon would pass a resolution urging the governor to "carve out," or exclude from KanCare, the long-term care services Medicaid provides for people with a developmental disability.
According to local officials contacted by KHI News Service, at least 20 counties have passed similar resolutions asking the governor to reconsider the reach of KanCare. At least three more are considering a resolution.
The first resolution was jointly endorsed March 5 by commissioners in Marion and Harvey counties. The Topeka-based Kansas Association of Counties later distributed copies of the document to the state's other 103 counties. Within a month, 18 other counties approved their own resolutions and more are expected to follow.
It's not clear if the resolutions will change the administration's approach. When the Legislature returns April 25 for its wrap-up session, lawmakers are expected to debate a proposal that would exclude long-term services for the developmentally disabled from KanCare.
An effort to debate the measure on the House floor was stymied by a procedural move at the end of the regular session, but supporters have pledged to bring it up again.
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