After months of trying to dance around the politically charged issue, the administration of Gov. Sam Brownback has openly acknowledged that the $139 million Medicaid enrollment system that it is building will be interconnected with the online health insurance exchange required by the Affordable Care Act, and that the system will be ready to go by the Oct. 1 federal deadline.
“It's just a connectivity kind of a thing,” said Dr. Robert Moser, secretary of the Kansas Department of Health and Environment, which is spearheading the project to overhaul the 26-year-old, paper-based system to a modern online one.
“I certainly appreciate the concerns that are tied to the political angst, but this program was well on its way when I came on board and my job is to make sure it gets completed successfully,” he said.
Entangled with the exchange
Overhauling the state’s antiquated Medicaid enrollment system has been in the works since at least 2009, when the project was called K-MED.
The project stalled briefly in August 2011, when Brownback returned a $31.5 million federal grant, most of which had been earmarked for developing the state’s new Medicaid enrollment system. Brownback said he was returning the grant because it was tied to the Affordable Care Act — which he he had pledged he would not implement prior to the U.S. Supreme Court ruling on the law, and later until after the 2012 federal elections.
Then that same month, administration officials announced a new contract with Accenture to develop the Kansas Eligibility and Enforcement System (KEES), using $118 million in federal funds to pay for the $139 million projected cost. K-MED became KEES.
A key condition of the federal funding was that the KEES system would have to be “interoperable” with the coming health insurance exchange — an online marketplace scheduled to launch Oct. 1 where consumers can compare and buy coverage that will begin Jan. 1, 2014.
In Kansas and the 25 other states that elected not to run their own health insurance exchanges, the federal government will build and operate them.
Moser said interoperability of KEES and the exchange means that — for consumers — there will be a single entry point for enrolling in private health insurance or in Medicaid, the state-federal health care program for low-income, elderly and disabled persons. Medicaid in Kansas is known as KanCare.
“You enter in some information, most of it is going to be yes/no. If you're eligible for Medicaid then it would pop up the KEES patient portal,” Moser said. “If it shows that your income level is such that you don't qualify for Medicaid…it's going to push your information over to the federal exchange. So those two systems literally will be handing back and forth inquiries.”
Moser said the fact KEES would interface with the insurance exchange was no different than integration with other federal computer systems, such as Homeland Security or the Internal Revenue Service.
“It doesn't really have that significant of an implication in my mind. But then again, I'm a physician and a little bit more patient-centered and look at the convenience factor. If that person is in a hospital setting and I think they need admitted, but they're worried about the cost because they don't have coverage, I'd like to be able to determine at that point in time 'Are they eligible for coverage' and use that as leverage to get them in to the hospital,” Moser said.
State insurance regulators are preparing a recommendation for Gov. Sam Brownback on what basic benefits should be available to Kansans who seek health insurance through the new online purchasing exchange that federal officials expect to be operational here within about 16 months.
A three-hour hearing to collect public input on what should constitute the state’s “essential health benefits” benchmark plan is scheduled for Wednesday. It is set to start at 9 a.m. in Shawnee Room A at the Maner Conference Center, which is next to the Capitol Plaza Hotel in Topeka.
“Our plan is to get some summary information (including a recommendation) over to the governor within a week or so after the hearing is over, and at that point it will be up to him to decide if he wants to make an election,” said Linda Sheppard, director of the accident and health division at the Kansas Insurance Department. Sheppard also is the agency’s project manager for matters dealing with implementation of the Affordable Care Act, the controversial federal health reform law that Brownback has pledged to have no part of until after the November presidential election.
Brownback, like other conservative Republicans, opposed the Affordable Care Act, first as a U.S. senator and then when he campaigned for governor in 2010. In August 2011, under pressure from GOP party activists, he spurned a $31.5 million federal “innovator” grant to Kansas to help the state create a health insurance exchange model for use here and possibly in other states.
He then said his administration would have nothing to do with “Obamacare” until after the U.S. Supreme Court ruled on the reform’s constitutionality. After the court largely upheld the law in June, he said he would do nothing to implement it until after the election.
Republican presidential nominee Mitt Romney and most Republicans running for Congress have vowed to repeal the law as a first order of business, if elected. In Kansas, conservative Republicans continued to use the reform law to bludgeon more moderate opponents in the party’s August primaries and were mostly successful with the tactic.
Insurance Commissioner Sandy Praeger is a moderate Republican who helped craft portions of the Affordable Care Act as part of her work on behalf of the National Association of Insurance Commissioners. She has consistently said that the law has shortcomings but allows flexibility to states in how it is implemented in some areas, and that Kansas should exercise those options in order to have programs more in tune with the state’s needs and desires.
The health reform law stipulates that the federal government will run the insurance exchanges in states that choose not to create their own and will have them up and running by Jan. 1, 2014. Likewise, in states where governors decline to choose the models for “essential benefits” offered through the exchanges, the federal government will do so.
Sheppard said if the federal government chooses the benchmark plan for Kansas, it could be one that is less affordable than a plan selected by those more familiar with the Kansas market.
Spokesmen for Brownback this week said they were unable to say whether the governor would pass on making a recommendation regarding essential benefits as he did on returning the exchange grant.
According to Sheppard, federal officials have set a Sept. 30 deadline for hearing from governors on their benchmark plan choices.
In Pittsburg, the community health center so desperately needed more space that last year staff converted closets and a bathroom into offices.
But next year the number of patients the center sees is expected to grow 24 percent, said Krista Postai, chief executive of the Community Health Center of Southeast Kansas.
"And I have no place to put them," she said. "This building is totally and completely at capacity."
That should soon change.
By December 2014, using a $4.7 million federal grant, the center will nearly triple its space from 15,000 to 40,000 square feet.
The grant was announced today by the U.S. Department of Health and Human Services. It is part of more than $21.6 million awarded to five Kansas community health centers.
About 40,000 new patients will gain access to care thanks to the construction and renovation projects funded by the grants, according to HHS.
The funding stems from the Affordable Care Act, which authorized $9.5 billion to expand health services over five years and $1.5 billion for construction and renovation at community health centers.
“For many Americans, community health centers are the major source of care that ranges from prevention to treatment of chronic diseases," HHS Secretary Kathleen Sebelius said in a prepared statement. "This investment will expand our ability to provide high-quality care to millions of people while supporting good paying jobs in communities across the country.”
The grant amounts for the other Kansas health centers were:
■ $2.7 million for the Salina Family Healthcare Center in Salina.
■ $4.6 million for Hunter Health Clinic in Wichita.
■ $4.5 million for Konza Prairie Community Health Center in Junction City.
■ $5 million for PrairieStar Health Center in Hutchinson.
The grant funds were disbursed directly to the health centers, which are private, nonprofit organizations.
In Pittsburg, the new construction is set to begin in July and finish by December 2014, Postai said.
The center will then be able to expand most existing services as well as add optometry, physical therapy and speech therapy services. An estimated 8,200 additional patients will be able to access the center.
Plans are to add 42 positions at an average salary of $45,700 as a result of the expansion, center officials said.
The waiting room has been at capacity for years with more demand on it after one of the area's biggest employers was shuttered at the end of 2008. The wheel maker Superior closed as the auto industry crashed and the number of people near Pittsburg without insurance shot up from 12 percent in 2009 to nearly 18 percent in 2010.
"From the time we open, it is wall-to-wall people. We need space," Postai said. "You can only be open so many hours and you can only schedule so creatively. And our efficiency has been impacted by our lack of space."