WellCommons

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.

Kansas Lt. Gov. Jeff Colyer, left, discusses proposed changes for the state's Medicaid program, Tuesday, Nov. 8, 2011, at the Statehouse in Topeka. Watching to his right is Gov. Sam Brownback, who had Colyer lead the team drafting the proposals.

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.