TOPEKA (AP) — Gov. Sam Brownback says Kansas will have a federally run health insurance exchange, after he declined to support Insurance Commissioner Sandy Praeger's application for a state-federal partnership.
Brownback had said months ago he would wait until after Tuesday's election before moving forward on health care. He announced his decision Thursday after meeting with Praeger, who sought the governor's signature on a letter of support for a state-federal exchange.
Brownback's decision illustrates the divide over the federal health care law between the conservative Republican governor and the moderate Republican commissioner.
States have until Nov. 16 to inform the federal government if they plan to create their own health insurance exchanges, partner with the federal government or have their exchanges run by federal agencies.
By John Hanna, Associated Press
TOPEKA — Gov. Sam Brownback’s allies have raised the potential expansion of the state’s Medicaid program as a campaign issue in the days before Tuesday’s election decides races for the Kansas Legislature, with conservative Republicans seeking to bind Democrats to President Barack Obama and the federal health care overhaul.
The federal law enacted in 2010 contemplates an expansion of Medicaid to cover millions of uninsured Americans, and it promises that the federal government will pick up the full cost until 2016 and most of it afterward. A U.S. Supreme Court’s decision in June said states could refuse to expand their programs, which provide health coverage for the poor, the disabled and elderly.
Many Kansas Republicans are skeptical of the funding promises, noting the federal government’s ongoing budget problems. Officials assume Brownback will declare after the election whether Kansas will opt in or out of the expansion, but retiring House Speaker Mike O’Neal, a conservative Hutchinson Republican who’s also chief executive officer of the powerful Kansas Chamber of Commerce, said last week that voters need to know whether legislators and candidates would support an expansion.
The chamber already has attacked Democrats for opposing a proposed health care “freedom” provision for the state constitution, protesting the federal law’s mandate that most Americans buy health insurance starting in 2014. O’Neal issued his statements as Democrats were pointing out that the measure was largely symbolic, countering the chamber’s assertions in mailings that the proposal would “stop the Obama agenda at the Kansas border.”
But the Medicaid issue also ties into longstanding Republican themes portraying Democrats as advocates of big government. A report in July from the nonpartisan Kaiser Family Foundation said an expansion would cover nearly 264,000 adults in Kansas — where 393,000 residents now receive health coverage through the state.
“The simple fact is, we can’t afford it,” said House Majority Leader Arlen Siegfreid, a conservative Olathe Republican, adding that if Obama is re-elected, “We’re going to be watching that very closely.”
Democrats aren’t openly embracing a Medicaid expansion, even if they believe it would reduce the number of uninsured Kansans. They contend the state can’t seriously contemplate any additional spending because of massive income tax cuts enacted this year.
Kansas Democratic Party Chairwoman Joan Wagnon said any discussion of expanding Medicaid was “rendered moot” when Brownback signed the tax cuts in May. Legislative researchers estimate that the cuts are worth $4.5 billion over the next six years and project that the reductions — meant to stimulate the economy — will produce collective budget shortfalls approaching $2.5 billion during the same period.
“He’s dug a hole as big as the Grand Canyon in the budget,” Wagnon said.
By Associated Press
TOPEKA - Gov. Sam Brownback's administration is trying to reassure Kansas legislators that Medicaid participants won't suffer if the federal government delays an overhaul of the program.
State Division of Health Care Finance Director Kari Bruffett said Wednesday that services won't be interrupted if the state can't go ahead with its Medicaid overhaul in January as planned.
The Topeka Capital-Journal reports Bruffett told the Legislative Budget Committee that the state remains committed to the Jan. 1 start date. Critics say Brownback's administration is moving too quickly, which it denies.
Brownback plans to turn administration of the $2.9 billion-a-year Medicaid program over to three private companies. Medicaid covers health care for poor, disabled and elderly Kansans.
The state needs the federal government to waive some of its rules to implement its program.
By John Hanna, Associated Press
TOPEKA (AP) — Kansas' insurance regulator is asking Gov. Sam Brownback to spell out the requirements for health coverage to be sold in a new online marketplace mandated by the federal health care overhaul, but Brownback still plans to make no decisions until after the presidential election.
Insurance Commissioner Sandy Praeger made her recommendations public Tuesday, a day after she sent the conservative Republican governor a letter containing her proposals for the "benchmark plan" that companies must offer to participate in the online marketplace. The federal health care law says such marketplaces, known as exchanges, will start operating in 2014.
Praeger's proposal calls for requiring companies to offer the same coverage Blue Cross Blue Shield of Kansas does in its comprehensive plan for small groups, along with additional coverage for children's eye and dental care. The commissioner noted in her letter that if Brownback does not set the state's requirements by the end of September, the U.S. Department of Health and Human Services could do it for the state.
Brownback has strongly criticized the federal health care law, enacted in 2010 and championed by President Barack Obama. Praeger, a moderate Republican, has praised the law as an important step toward providing universal access to health insurance, and she and Brownback disagree over how aggressive the state should be in setting up an exchange.
"My administration will not make any decisions regarding the implementation of Obamacare until after the November elections," Brownback said in a statement Tuesday, reiterating the stance he's long held.
States have until Nov. 16 to declare whether they still want to be partners in running an exchange or leave it entirely to the federal government. Kansas hasn't started to set one up because Brownback and Republicans who control the Legislature oppose the law. Brownback has argued that if Republican Mitt Romney defeats Obama, many requirements in the law are likely to be waived.
Praeger's proposal for the exchange's benchmark plan is designed to give consumers who use the online marketplace familiar coverage at competitive prices, said Linda Sheppard, the Insurance Department's project manager for the health overhaul.
"That does help the market stay stable," Sheppard said.
The federal government limited Kansas and other states to setting their benchmarks based upon 10 health plans already widely available to their consumers.
Blue Cross Blue Shield of Kansas provides coverage for about 900,000 Kansans, and Praeger is proposing that the exchange benchmark be tied to its most popular small group plan. At the end of March, more than 30,000 people were enrolled in it.
"Selecting this plan will allow for the most continuity in the marketplace as a large number of Kansans already have these benefits through their small business employer or as individuals," said company spokeswoman Mary Beth Chambers.
HHS has already said it would base its benchmark for Kansas on the same plan.
But the federal health care law requires that the benchmark include coverage for children's eye and dental care, and the biggest health plans in Kansas generally don't, except through supplemental policies. Praeger proposes that coverage for those plans mirror what's available through the state for children of working-class families that can't afford private insurance.
Sheppard said that if HHS sets the benchmark for Kansas, it could mandate different coverage for such services, as well as coverage for services such as speech and physical therapy.
"This is all kind of coming together in a really short time frame," she said. "The companies are obviously really anxious to get the benchmark set as early as possible."
By John Hanna, Associated Press
TOPEKA -- Kansas Insurance Commissioner Sandy Praeger says the state shouldn't wait until after November's presidential election to move toward complying with a key part of the federal health care law.
Praeger's comments Thursday about the U.S. Supreme Court's decision upholding the federal law put her at odds with Gov. Sam Brownback, a fellow Republican.
Brownback said he wants to wait until after the election to decide what Kansas will do about setting up an online health insurance marketplace. The health care law requires each state to have one operating in 2014.
The governor predicted that if GOP presidential nominee Mitt Romney gets elected, states won't face the requirement.
But Praeger says the state should still work on an online marketplace so that it has some say in how it's run.
By John Hanna, Associated Press
TOPEKA — Gov. Sam Brownback said Thursday that he wants to wait until after the November presidential election to move Kansas toward compliance with a key provision of the federal health care overhaul upheld by the U.S. Supreme Court.
Brownback told reporters that putting the 2010 health care law into effect in Kansas and other states is a political issue to be resolved by voters.
"If the American people don't want Obamacare, it's a political issue, and it's about this fall presidential race, whether or not you want to implement it," Brownback said. "I want to see what happens in the fall."
Brownback said that if GOP presidential nominee Mitt Romney unseats Democratic President Barack Obama, who championed the law, states are no longer likely to face a requirement to set up exchanges to help consumers buy health insurance. Exchanges would be online marketplaces for health insurance, allowing consumers to comparison shop, and are sometimes described as the health coverage equivalent of websites such as Travelocity.
The federal law requires each state to operate an exchange by 2014, and plans must be submitted by Nov. 16 to the U.S. Department of Health and Human Services. Kansas has not started to set one up because of opposition to the entire law by Brownback and fellow Republicans who dominate the Legislature.
Kansas has about 350,000 residents who don't have health insurance coverage, or 12.7 percent of the state's population, according to U.S. Census Bureau figures. About 53,000 are children.
Last year, Brownback returned a $31.5 million federal grant to assist the state with the computer infrastructure for an exchange.
Brownback said if Romney is elected, states are likely to get a blanket waiver from the requirement to have exchanges. Under the law, the federal government could operate its own exchange if a state refused to set one up.
The Supreme Court decision is likely to frustrate and anger many Kansas Republicans. Freshman U.S. Rep. Tim Huelskamp, a GOP conservative, promised to work for the law's repeal and called Thursday "a definitive date in the advance of government tyranny."
But Kansas House Insurance Committee Chairman Clark Shultz, a Lindsborg Republican, said state officials ought to at least discuss what options Kansas has should an exchange be required.
"It seems that we should at least have something in mind on how we go forward if we need to," Shultz said.
Kansas House Minority Leader Paul Davis, a Lawrence Democrat, predicted that even if Romney is elected, he'll have to consider creating exchanges as part of any plan for reforming the health care system.
"He is going to have to deal with the rising cost of health care and the limited options that consumers have in the marketplace," Davis said. "I have really yet to hear the governor or anybody in the Republican Party articulate what the problem with a health insurance exchange is. Until they do that, we're not having much of a meaningful dialogue here."
Insurance Department officials, under Insurance Commissioner Sandy Praeger's supervision, have said they don't believe the state would have enough time to develop its own exchange. They have suggested that Kansas could seek a partnership with the federal government or have the federal government run the exchange.
Praeger, a Republican, didn't touch on those issues in the statement she issued immediately after the law was upheld.
"The law will be refined as we go forward just as many laws are, but it establishes as public policy the importance of everyone in this country having access to affordable health care," Praeger said.
But she also acknowledged: "We are going to have to wait, however, to see what the November election holds regarding the law's long-term future."
By Associated Press
"Stopping ObamaCare is now in the hands of the American people. It begins with electing a new president this fall." — Kansas Republican Gov. Sam Brownback.
"This is the wrong decision for our country. After two years, we have seen the problems and pitfalls of this law and they fall squarely on the shoulders of patients and Kansas families. The Court has affirmed that Obamacare is a new, additional tax. Care will cost more, and access to quality care will be reduced. No wonder a majority of Americans oppose it." — U.S. Sen. Pat Roberts, R-Kan.
"While I am disappointed by the decision, it just further highlights the importance of electing a Congress that does not pass bad policy in the first place. The Obama Administration and the last Congress ignored the public concerns and ramrodded this bad legislation through the legislative process. Unlike the legislative and executive branches, the judicial branch does not have the responsibility to listen to public opinion or to ensure a particular policy is good for the nation; they are merely tasked to determine if the Constitution permits it. While I disagree, in the judgment of the Supreme Court, it does." — U.S. Rep. Lynn Jenkins, R-Kan.
"I understand the concerns with the individual mandate. Those were concerns that frankly I share with a lot of Americans about the government's ability to require every individual to purchase health care. I hope that we can move on from the discussion we've been having about health care and try to do what we can to fix what is a very inefficient system and one that's not working very well for all Americans right now and move forward." Kansas House Minority Leader Paul Davis, D-Lawrence.
"I continue to believe that the health care reform law jeopardizes access to quality health care for many Americans, threatens the survival of Kansas communities, and stifles our country's job growth through higher taxes and burdensome regulations. The right direction for our country is for Congress to repeal this unsound law and enact targeted reforms that will actually drive down health care costs and strengthen access to quality care." — U.S. Sen. Jerry Moran, a Kansas Republican.
"It will lower the quality, and increase the cost, of care for all Americans. It is a tremendous burden on small business and our struggling economic recovery, and we simply can't afford it. After today's decision, we must first repeal the administration's health care law, and begin bipartisan efforts to find bold solutions to our health care challenges that can reduce cost, improve the quality of care and ensure every American has health care access without a large federal takeover of our health care system." — U.S. Rep. Kevin Yoder, R-Kan.
"The President's health care law has been making things worse for Americans by driving up health costs and making it harder for small businesses to hire workers. The only way to alter course is to repeal ObamaCare in its entirety. I am disappointed that the Court did not side with the majority of Americans who are concerned with this law." — U.S. Rep. Mike Pompeo, R-Kan.
"We are thrilled the court has upheld the important consumer protections in the Affordable Care Act. There are more than 350,000 Kansans who do not have any health insurance and many Kansans have insurance that is inadequate to cover them when they get sick or have an accident. The Affordable Care Act will continue to help cover many hard-working Kansans who are struggling to afford health coverage for themselves and their families." — Anna Lambertson, executive director of the Kansas Health Consumer Coalition.
"This addresses the problem of access to health care, and now we have to find ways to bring costs under control. The law uses a market-driven approach with a measure of compassion to let people buy their own health insurance at the cost and coverage they can afford. We are going to have to wait, however, to see what the November election holds regarding the law's long-term future." -- Kansas Insurance Commissioner Sandy Praeger, a Republican.
"Today's decision marks the beginning of a new era in health care coverage for Kansas children and their families. Working families will no longer be denied coverage due to a pre-existing condition or lose their coverage when someone gets sick. More secure health care coverage, as a result of the ACA, will finally give hardworking Kansas families some peace of mind. " — Shannon Cotsoradis, president and CEO of Kansas Action for Children.
By John Hanna, Associated Press
TOPEKA — Subsidiaries of three large, out-of-state health insurance companies were hired Wednesday to manage Kansas' Medicaid program, and Gov. Sam Brownback's administration said the contracts were expected to produce even greater cost savings over the next five year than previously anticipated.
The contracts are key to the conservative Republican governor's efforts to overhaul the $2.9 billion-a-year Medicaid program, which provides health coverage to the poor, disabled and elderly. He and top administration officials have said the changes — moving all Medicaid participants into managed care — will provide better-coordinated care while controlling the state's costs.
The state awarded the contracts to Amerigroup Kansas Inc., United Healthcare of the Midwest Inc. and Sunflower State Health Plan. The Amerigroup Corp. parent is based in Virginia Beach, Va.; Sunflower is a subsidiary of Centene Corp., which has its headquarters in St. Louis, and United Healthcare is based in Minneapolis. They were among five bidders.
Brownback's administration had projected that the state would save $853 million over the next five years because of the overhaul, based on expectation that the changes would lower the annual growth in its costs. The administration said Wednesday that savings over the next five years should now exceed $1 billion. Critics of the overhaul had been skeptical of previous projections, however.
The new contracts are effect Jan. 1, and the three companies will offer competing plans so that Medicaid participants have choices. The overhauled program will be called KanCare.
"These new KanCare plans will provide our most vulnerable Kansans with superior service at a more sustainable price," said Lt. Gov. Jeff Colyer, a surgeon and former state senator who led the team that developed the overhaul plan.
The state still needs the federal government's permission to go ahead with the overhaul, because it provides a majority of the funds for Medicaid. The U.S. Department of Health and Human Services would have to waive some of its Medicaid rules.
The unsuccessful bidders were Coventry Health Care of Kansas, affiliated with Coventry Health Care, of Bethesda, Md., and WellCare of Kansas, affiliated with WellCare Health Plans Inc., based in Tampa, Fla. The administration's announcement did not say why the other firms were chosen over them.
Most of the nearly 385,000 Kansans receiving state medical assistance are covered by managed care through private contractors, but the Medicaid overhaul represents the first time the state has tried to include relatively expensive, long-term care for the disabled and the elderly, including those in nursing homes.
Advocates for the developmentally disabled have been vocal critics of the overhaul. Their concerns led Brownback to agree to wait until 2014 to deal with long-term services for the developmentally disabled in the contracts, while permitting pilot programs.
TOPEKA (AP) — Kansas plans to resubmit a request to the federal government for permission to overhaul the state's $2.9 billion-a-year Medicaid program.
State officials said Tuesday they want to solicit additional comments about the overhaul from Indian health clinics in Lawrence and White Cloud.
Gov. Sam Brownback's administration said the move won't change plans to issue contracts this summer to three private insurers to manage Medicaid, which covers health care for the poor, disabled and elderly. The contracts would start in January.
The state needs the federal government to waive Medicaid rules. Kansas filed a request in April.
Brownback's administration acknowledged the Indian clinics weren't formally notified of the state's plans as it consulted with leaders of the four tribes with Kansas reservations. Two public hearings are planned.
By John Hanna ,Associated Press
TOPEKA — Kansas has formally asked the federal government for permission to overhaul Medicaid, applying for a waiver of rules that would impede Gov. Sam Brownback's efforts to turn the state's entire $2.9 billion-a-year program over to private, managed-care companies.
Brownback's office declined Friday to discuss its waiver application until an afternoon news conference. But the federal Centers for Medicare and Medicaid Services confirmed for The Associated Press that it received the application Thursday.
The conservative Republican governor plans to turn the state's Medicaid program — which covers health care for the poor, disabled and elderly — over to three companies, starting Jan. 1, 2013. The administration expects to issue contracts this summer, though it has promised to delay including long-term services for the developmentally disabled in the overhaul until Jan. 1, 2014.
The federal government must approve some changes because it provides a majority of the funds for states' Medicaid programs. Brownback's administration said in February that it would seek a waiver of some rules to allow its overhaul to go forward, as well as a "global" waiver of all rules to allow further changes later.
Neither the federal centers nor the governor's office released a copy of the application before an expected Statehouse news conference by Lt. Gov. Jeff Colyer, a surgeon who led the team that developed the Medicaid overhaul plan. But the administration previously has said a federal waiver is necessary to cover all Medicaid participants in a managed-care program.
The centers are part of the U.S. Department of Health and Human Services, and its secretary, Kathleen Sebelius, is a Democrat who previously served as Kansas governor.
Most of the 387,000 Kansans receiving state medical assistance are covered by managed care through private contractors, but the Medicaid overhaul represents the first time the state has tried to include relatively expensive, long-term care for the disabled and the elderly, including those in nursing homes.
The administration argues the overhauled Medicaid program — to be called KanCare — will better coordinate care for participants, improving their long-term health. The administration also projects the overhaul will reduce the state's costs and savings are crucial because the federal government, facing its own budget problems, is likely to cut its Medicaid funding.
But advocates for the developmentally disabled have been vocal critics of the overhaul. Their concerns led Brownback this week to endorse a proposal from state House Majority Leader Arlen Siegfreid, an Olathe Republican and normally an ally of the governor, to delay including long-term services for the developmentally disabled in the contracts, while permitting pilot programs.
Critics worry the overhaul will insert an extra layer of bureaucracy between disabled Kansans and service providers, noting many clients receive long-term services that don't resolve medical issues but help them live as independently as possible. Many don't trust assurances that private companies won't be allowed to cut services or payments to service providers.
By John Hanna, Associated Press
TOPEKA - A Republican leader and frequent ally Gov. Sam Brownback said Wednesday that he'll try to delay part of the GOP governor's plan to overhaul the state's Medicaid program, and several hundred people rallied at the Statehouse to protest changes for the developmentally disabled.
House Majority Leader Arlen Siegfreid confirmed he is drafting a proposal to exclude long-term services for the developmentally disabled for a year from Medicaid contracts Brownback's administration plans to issue this summer. The contracts will turn the $2.9 billion-a-year program over to three private, managed-care companies, starting Jan. 1, 2013.
Siegfreid, an Olathe Republican, said he'll offer his proposal this week as an amendment to the state budget. It will allow pilot projects to test whether a managed-care program can deliver long-term services to the developmentally disabled. Advocates for the disabled have been the most vocal critics of Brownback's efforts to overhaul Medicaid, which covers medical services to the poor, needy and disabled.
Most of the 387,000 Kansans receiving state medical assistance are covered by managed care though private contractors, but the Medicaid overhaul is the first time the state has tried to include relatively expensive, long-term care for the disabled and the elderly, including those in nursing homes. Under Siegfreid's plan, the state would "carve out" long-term services for the developmentally disabled until 2014.
"It will give us another year to look at it, to see if it works," Siegfreid said.
Brownback's office did not immediately respond to Siegfreid's proposal, but it has said the overhauled Medicaid program — to be called KanCare — will better coordinate care for participants, improving their long-term health. The administration also has said the overhaul will reduce the state's costs and savings are crucial because the federal government, facing its own budget problems, is likely to cut its Medicaid funding.
Some members of the Republican-controlled Legislature agree, particularly Brownback's fellow GOP conservatives, and they've blocked efforts to tinker with the overhaul.
Participants in Wednesday's rally left personal items on the Statehouse's south steps in a temporary display to urge Brownback to change his plans and persuade legislators to intervene.
The administration has said repeatedly that the Medicaid contracts will require the companies to work through existing providers of services for the developmentally disabled and won't allow the contractors to cut payments to those service providers.
But critics worry such assurances won't hold in the future. They also argue that Kansas already has a good system for the developmentally disabled, in which 27 regional groups have contracts with the state to serve as its gatekeepers, determining who qualifies for services. They also note that developmentally disabled Kansans often receive services that don't resolve medical issues but help them live as independently as possible.
Jerry Michaud, president and chief executive officer of Developmental Services of Northwest Kansas, one of the regional gatekeepers based in Hays, said Brownback's overhaul would add "an unnecessary level of complexity."
"This is not a forte for managed-care companies," he said. "I can understand the administration's desire to have everything in one pot, but it is different."
By John Hanna, Associated Press
TOPEKA - Gov. Sam Brownback and several top administration officials sought to dispel doubts about his plan to overhaul the state's Medicaid program, declaring Thursday that the planned summertime reorganization of three government departments will improve services for the poor, disabled and elderly.
The conservative Republican governor plans to turn over management of the entire $2.9 billion-a-year Medicaid program next year to three private companies. Before then, in July, the state will reorganize its departments of Aging, Health and Environment and Social and Rehabilitation Services.
Brownback, Lt. Gov. Jeff Colyer and the three agencies' secretaries had a Statehouse news conference to publicize the coming reorganization, which will consolidate programs providing long-term care for both the elderly and disabled into one agency. The reorganization also will eliminate 10 administrative jobs and permit SRS to focus on services for families and children.
Administration officials said the agencies' reorganization is a crucial to overhauling Medicaid to improve the coordination of care and overall health of participants and reduce the state's costs. The overhaul has drawn bipartisan criticism, though the agencies' reorganization attracted no significant legislative opposition.
Brownback issued an executive order in February to reorganize the agencies, and the state constitution gave legislators until last week to block it. They didn't act before starting their annual spring break at the end of March.
"We want Kansas to work better," Brownback said. "We want it to work more efficiency, so that we can afford the services that our vulnerable community needs."
Brownback's administration is reviewing bids from five companies that are all based outside Kansas or are affiliates or subsidiaries of out-of-state companies. The administration plans to issue three contracts this summer, with each company operating statewide so Medicaid participants have a choice of managed-care coverage.
Most of the 385,000 Kansans receiving state medical assistance have managed-care coverage through private contractors, but the overhauled Medicaid program, to be called KanCare, would be the first time Kansas has brought the disabled and elderly, including those in nursing homes, into such a system. An increased number of Kansans needing relatively expensive long-term services would be covered by managed care.
Legislators reconvene April 25, and advocates are expected to push lawmakers to "carve out" services for the developmentally disabled from the KanCare contracts. Advocates persuaded the Shawnee County Commission to adopt a resolution Thursday asking Brownback to reconsider the overhaul, The Topeka Capital-Journal reported.
Senate Minority Leader Anthony Hensley, a Topeka Democrat, said the news conference with the governor, three Cabinet secretaries and Colyer, the architect of the Medicaid plan, shows Brownback's administration understands it still faces a "hard sales job."
"There's a lot of skepticism about this whole issue," Hensley said.
The reorganization will move oversight of the state's five hospitals for the mentally ill and developmentally disabled from SRS to the Department on Aging, along with other services for the disabled and mentally ill. The Department on Aging also will take over some regulatory functions from the health department.
It will become the Department on Aging and Disability Services. The health department will oversee Medicaid's financial management, and SRS will become the Department of Children and Families.
SRS Secretary Phyllis Gilmore said that as part of its new, narrower focus, reorganized her department will seek to hire at least 20 additional social workers to help children in troubled families.
Colyer said: "The point of this is focus, and so what we're trying to do is focus on core missions."
TOPEKA (AP) — Gov. Sam Brownback is preparing to fill a vacancy in his Cabinet and sign an executive order that advances his plan to overhaul the state's Medicaid program by reorganizing three state agencies.
Brownback's staff wasn't saying ahead of his Friday morning news conference what major administrative position would be filled.
However, Jeff Kahrs (KARS) has been serving as acting secretary of the Department of Social and Rehabilitation Services since Secretary Rob Siedlecki stepped down at the end of last year.
SRS would be reorganized under the Medicaid plan, along with the Department on Aging and the Department of Health and Environment. Programs would be shifted among the agencies, and they'd get new names.
The $2.9 billion Medicaid program provides health coverage for the poor, disabled and elderly.
By John Hanna, Associated Press
TOPEKA -- Republican Gov. Sam Brownback won't delay an overhaul of Medicaid in Kansas, officials said Thursday, despite bipartisan concern among legislators that his administration is moving too quickly to turn the entire program over to private health insurance companies.
Brownback expects the state to issue contracts this year to three companies to manage the $2.9 billion program, which provides health coverage to poor families and disabled and elderly Kansans.
The contracts would take effect Jan. 1, 2013. Each company must provide coverage statewide, so that participants can choose among plans. The administration also is promising that the contracts will contain financial incentives for the contractors to improve services while controlling costs.
State medical programs provide services for an average of 380,000 people a month, and the bulk already receive state health coverage through private contractors. But Brownback's overhaul represents the state's first attempt to bring services for the disabled and the elderly, including nursing home residents, into a managed-care system.
Some legislators think Brownback's administration is rushing the changes, but Lt. Gov. Jeff Colyer said when the new contracts take effect next year, nearly two years will have passed since the administration began discussions about overhauling Medicaid. Colyer said the changes will not only to control costs but better coordinate care and improve individuals' health.
Asked about delaying the overhaul, Colyer told The Associated Press, "Why would we?"
"We don't want to hurt Kansas patients," said Colyer, a surgeon and former state senator who led the team that developed the overhaul plan. "We want to make sure that they start getting the benefits now, and we're talking about tens of millions of dollars."
Companies seeking one of the Medicaid contracts have until Tuesday to submit the technical details of their proposals to the state, then until Feb. 22 to submit the rest. Up to 15 companies can bid, including Aetna Inc., United Healthcare, WellPoint Inc. and Blue Cross and Blue Shield of Kansas, the state's largest health insurer.
"The bottom line is no — no, the administration is not considering delaying it," said Brownback spokeswoman Sherriene Jones-Sontag.
Legislators have acknowledged that their role in the overhaul will be limited because most changes will be handled through the contracts, though they must agree to a reorganization of the state's health and social services agencies, and they can weigh in on budget issues.
The House Health and Human Services Committee planned to hear a presentation Thursday afternoon from Health and Environment Secretary Robert Moser, a physician who also was on the Medicaid overhaul team. The Senate Public Health and Welfare Committee heard testimony earlier this week.
Sen. Dick Kelsey, a Goddard Republican, said Brownback should delay the start of the Medicaid contracts for six months, until July 1, 2013, and remove services for the developmentally disabled from the contracts. Some Democrats also have said the administration should slow down.
"I don't believe that changes this massive can be made in this time frame successfully," Kelsey said. "It will be a tremendously chaotic thing."
Rep. Jerry Henry, of Cummings, the top Democrat on the House Social Services Budget Committee, said he's most concerned about how the overhaul will affect services in rural areas, where providers are fewer. He said the administration could do better by imposing changes in urban areas first then expanding into rural areas.
Advocates for the developmentally disabled also have voiced concerns about how the changes will affect services and clients' existing relationships with community service groups.
Tom Laing, executive director of InterHab, a group representing service providers, said managed-care providers focus on administering services to lessen future medical problems and costs. But, Laing said, while developmentally disabled Kansas could benefit from such an approach for medical or mental health services, they also depend upon in-home services designed to promote their independence.
Brownback's administration has promised that new contracts will require companies to work through existing service providers. Also, Colyer said, Kansans with long-term needs will benefit the most from having better-coordinated services.
If the state delays the overhaul, Colyer said, "It will cost us millions of dollars, and it's a worse health outcome."
Senate health committee Chairwoman Vicki Schmidt, a Topeka Republican, doubts legislators can force Brownback's administration to alter its schedule for overhauling Medicaid. Instead, she said, she wants to create an oversight committee to monitor the effort.
Other legislators acknowledged that they're relying on public pressure to persuade the administration to slow the overhaul.
"If you move too quickly on this, it's bound to fail," said Sen. Laura Kelly, of Topeka, the ranking Democrat on the budget-writing Senate Ways and Means Committee.
For the past few weeks, health organizations have been absorbing the details from Kansas Gov. Sam Brownback’s proposal to reorganize how the state handles Medicaid.
As those health providers get further into the plan’s details, reactions are mixed.
On Nov. 8, Brownback announced a new system called KanCare, which is designed to save the state hundreds of millions of dollars in health care costs. The three major changes in the plan include:
- The state would contract with three health insurance companies to provide Medicaid services.
- All Medicare clients would receive managed care.
- Responsibilities for parts of Medicaid will shift among three state agencies.
In his overview of the reforms, Lawrence Memorial Hospital’s chief financial officer, Simon Scholtz, recently told the hospital board that “providers have a lot more responsibility than they ever had before.” More reporting and adherence to quality measures would be required. And the plan offers incentives for quality performance, such as reduced emergency room visits.
Another major change would be that each patient would have a care manager, who would help coordinate the patient’s care with different health services, prevention programs and family support.
“It is very much what we are doing with some patients. They are going to try to do it with all Medicaid patients, which will be interesting,” Scholtz said.
Under the new system, Scholtz said, health providers may be held to what those care managers say. Value-added services, such as smoking cessation and weight-loss programs are also a key part of the reforms.
“It’s very much a health-orientated approach rather than sick care,” Scholtz said.
David Johnson, CEO of Bert Nash Community Mental Health Center, said the reforms appear to be a good thing for his organization, which works with about 1,000 Medicaid patients. Community mental health groups had reached out to the governor before the reforms were announced.
“It’s pretty clear they listened,” Johnson said.
Under the new system, organizations like Bert Nash could become health homes, which would work with a team of health care providers to coordinate care, for those with serious and persistent emotional disturbances. It also allows them to continue rehabilitation services for those with serious mental illnesses.
“No reason why a new system has to mean any further reduction in service. And, this just doesn’t do that,” he said. “In some ways it could help.”
Some health care providers are still muddling through the details. Jon Stewart, CEO of Heartland Community Health Center, is one of them.
Right now Medicaid patients are just a small percentage of the population the safety net clinic serves. But in the next few years that is likely to change as federal regulations go into place increasing the number of people who qualify for Medicaid.
Part of the difficulty, Stewart said, is gauging how the two sets of reforms will integrate with each other.
“I think it is too early to tell if it is good or bad,” he said.