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."

House Budget Committee Chairman Rep. Paul Ryan, R-Wis., holds up a copy of his budget plan entitled "The Path to Prosperity," Tuesday, March 20, 2012, during a news conference on Capitol Hill in Washington. The House adopted the plan on March 29. Families USA, a nonpartisan health consumer group, released a pair of reports Tuesday that outlines how the plan would decimate health care funding.

The Republican budget plan that recently passed in the U.S. House of Representatives would decimate health care funding in states across the country, according to reports released Tuesday.

States would lose more than $2.75 trillion during the next decade in federal funding for Medicaid and Medicare programs and for middle-class tax credits. The cuts would range from $5.3 billion in Wyoming to $303.8 billion in California. In Kansas, the cost would be $18.8 billion.

“The House Republican budget not only slashes funding to the states, it would decimate health coverage for seniors, people with disabilities, children and middle class families. It would force seniors to pay thousands of dollars more for Medicare coverage, and it would take away their ability to afford needed medicines,” said Ron Pollack, executive director of Families USA, a national consumer health group, which released the reports and says it is nonpartisan.

He said the proposal would end the Medicaid and Medicare programs as they exist and would repeal the Affordable Care Act, which was passed in 2010. The Medicare system would be replaced with a voucher-based premium support system for beneficiaries born after 1957. It also would eliminate Medicare coverage for 65- and 66-year-olds.

Here’s a look at how much federal funding Kansas would lose during the next 10 years under the GOP budget plan:

• $5.3 billion — for Medicaid program that serves about 340,000 low-income elderly, children and disabled residents.

• $4.6 billion — for expansion of Medicaid program. Under the Affordable Care Act, Medicaid eligibility would be expanded to include anyone who earned 133 percent of the federal poverty level or less. The GOP budget plan eliminates the expansion.

• $6.9 billion — in tax credit dollars. The Affordable Care Act provides significant tax credit subsidies for middle-class families so that they can better afford health care coverage. The budget plan eliminates those subsidies.

• $1.9 billion — for Medicare program. Among the Medicare cuts would be eliminating help for seniors who fall into the coverage gap for prescription drugs, commonly called the doughnut hole. Currently under the Affordable Care Act, seniors who fall into the gap receive a 50 percent discount on brand name drugs. In 2011, 40,900 Kansans fell into the coverage gap but received an average $610 through the Affordable Care Act, or ACA. The gap would ultimately be eliminated under ACA, but the GOP budget plan would completely reopen it.

Families USA report outlines Medicare changes under GOP budget plan. uploaded by kbritt

The budget proposal was introduced by Budget Chairman Paul Ryan, R-Wis., and was passed March 29 on a near party-line vote of 228-191. Kansas Reps. Lynn Jenkins, Kevin Yoder and Mike Pompeo voted in support of the plan, while Tim Huelskamp voted against it.

The Senate will now decide whether to adopt the budget or not. Pollack said most people think it will not pass the Senate because the majority of its members are Democratic, and no House Democrat voted for the bill.

“It may very well be that because we are in an election year, gridlock will continue throughout the course of this calendar year, and we may not have major changes with respect to the budget,” Pollack said.

To view the reports, visit familiesusa.org.

A New York Times graphic shows how the House voted. uploaded by kbritt

During a February town hall meeting in Lawrence, about a half dozen people wore shirts that supported having the developmental disability population carved out of KanCare, the state's managed care system for Medicaid. by Karrey Britt

TOPEKA — Democratic legislative leaders said Monday they still believe there is a chance to maintain the current system of assistance for those with developmental disabilities and prevent it from becoming part of Gov. Sam Brownback's plan to contract with insurance companies to manage Medicaid.

"The carve-out issue is not going away," said Senate Minority Leader Anthony Hensley, D-Topeka.

"Carve-out" refers to efforts by advocates for those with developmental disabilities to be removed from the Medicaid privatization plan, which would be called KanCare.

Brownback wants to contract with private insurance companies to handle the state's $2.9 billion Medicaid program that covers health care for the poor, elderly and disabled.

Last week, state Rep. Jim Ward, D-Wichita, tried to take a bill forming a KanCare legislative oversight committee and make an amendment to remove those with developmental disabilities from KanCare and maintain their current network.

Advocates of those with developmental disabilities have pleaded with Brownback to leave them alone, saying that the needs of those with developmental disabilities don't fit the managed care system proposed under KanCare.

But Brownback, a Republican, has rejected those pleas and promised that services will improve under KanCare and cost less.

A bi-partisan group of legislators spoke in support of Ward's amendment. But Brownback's allies in the House managed to have the entire bill sent back to committee before a vote could be taken on Ward's amendment.

The procedural move, however, won't make the issue go away, Democrats said.

"I still think there is a majority in the House to carve out the developmentally disabled portion of KanCare," said House Minority Leader Paul Davis, D-Lawrence. "There is broad support for doing that across the political spectrum," Davis said.

Davis said Brownback administration officials worked on House members to stop Ward's amendment. He said many of those officials were at another meeting related to KanCare and got messages to get to the House quick.

The bill was sent back to committee on a 69-54 vote with only Republicans voting to send it back. But Davis said he thought some Republicans who supported Ward's amendment also voted to send it back to committee simply to follow GOP leaders on a procedural move.

The Legislature convenes the wrap-up session on April 25 with numerous big issues still unresolved, including the budget, proposed tax cuts, redistricting and school finance.

Hensley said the opportunity for another debate on carving out the developmentally disabled from KanCare will arise again because many legislators are intent on approving the bill that sets up the oversight committee.

Cottonwood Inc. will ask Douglas County commissioners today for support in its quest to exclude people with intellectual and developmental disabilities from the state’s plan to privatize Medicaid.

This year, Cottonwood received $654,400 in funding from the county.

“When there are changes at the state level, it often falls back on the counties to have to pick up some of the slack,” said Sharon Spratt, chief executive officer of Cottonwood Inc. So she will ask commissioners to approve a resolution at their meeting today.

Under Gov. Sam Brownback’s proposed KanCare plan, the state will pay three for-profit companies to operate a managed care system. The system is designed to serve 383,000 low-income elderly, disabled and low-income families and children. Of those, 8,193 have developmental disabilities.

Managed care systems focus on preventive health care and getting patients the right medical services at the right time, Spratt said. But the Medicaid services provided to people with intellectual and developmental disabilities are for long-term care to allow them to live and work in the community.

“Our services don’t fit with the medical side of managed care,” Spratt said.

While the Brownback administration has given verbal assurances that case managers will remain with clients under KanCare, Spratt worries that their roles could change.

“We’ve worked for 40 years to have folks with developmental disabilities be seen as regular folks who are not sick,” Spratt said. “This seems like it kind of puts it back in that category.”

Lawrence Memorial Hospital received $432,000 this week through the Kansas Medicaid Electronic Health Records Incentive program. It was among 23 Kansas hospitals that received a collective $10 million. These were the first payments made through the program.

The hospitals received the money for promoting and achieving widespread adoption of health information technology, which improves the coordination and delivery of health care services for patients.

The Kansas Department of Health and Environment Division of Health Care Finance is responsible for issuing the payments through funding from the Centers for Medicare and Medicaid Services.

“Our goal is to improve the quality and coordination of care by connecting providers to patient information at the point of care through the use of electronic health records. These first payments under the incentive program score Kansas a significant milestone in our work to improve public health tracking and reporting and the overall standard of care as critical information is securely maintained and accessed by our providers.”

— Aaron Dunkel, KDHE deputy secretary

Ten eligible professionals, such as doctors, nurse midwives and dentists, also received payments totaling $212,500.

Here are the hospitals that received money and the amount awarded:

• Stevens County Hospital in Hugoton — $7,500.

• St. Luke’s Hospital of Garnett — $71,800.

• Hodgeman County Health Center in Jetmore — $79,700.

• Meade District Hospital — $91,700.

• Morton County Hospital in Elkhart — $108,000.

• Goodland Regional Medical Center — $171,800.

• Sumner County Hospital District 1 in Caldwell — $196,500.

• Pratt Regional Medical Center — $197,700.

• Newton Medical Center — $228,700.

• Neosho Memorial Hospital in Chanute — $254,900.

• Hutchinson Regional Medical Center — $301,600.

• Coffeyville Regional Medical Center — $323,400.

• Lawrence Memorial Hospital — $432,000.

• Western Plains Medical Complex in Dodge City — $452,900.

• Sumner Regional Medical Center in Wellington — $487,700.

• William Newton Memorial Hospital in Winfield — $506,500.

• St. Catherine Hospital in Garden City — $510,700.

• Mercy Health Systems of Kansas in Fort Scott — $513,700.

• Mercy Health System of Kansas in Columbus — $614,100.

• Overland Park Regional Med Center — $691,800.

• Shawnee Mission Medical Center — $842,600.

• Stormont Vail Health Care Inc. in Topeka — $1.4 million.

• Wesley Medical Center in Wichita — $1.8 million.

By Associated Press

TOPEKA - A man who once worked for two major health insurance companies is cautioning Kansas lawmakers and residents to question Gov. Sam Brownback's proposal to move the state's Medicaid program to a managed-care system.

Wendell Potter, a former public relations spokesman for Cigna Corp. and Humana Inc., spoke Tuesday to advocates for the developmentally disabled and testified before a Kansas Senate committee about his concerns with Brownback's plan, called KanCare.

Potter told the advocates that he doesn't question Brownback's or Lt. Gov. Jeff Colyer's motives. But, he added, "I will say that I'm certain there are ways to improve care and services and save money other than just handing you all over to for-profit insurance companies."

Five companies are bidding for three state Medicaid contracts for KanCare, which is scheduled to take effect Jan. 1. Those companies are Coventry, WellCare, United Health Care, Amerigroup and Sunflower State Health Plan, which is a subsidiary of Centene.

Potter said he decided to get out of the health care industry after such experiences as visiting a clinic in Tennessee where thousands of uninsured people waited for hours in the rain to receive care. The final straw was when a California girl, 17-year-old Nataline Sarkisyan, died after Cigna declined to pay for a liver transplant, The Topeka Capital-Journal reported.

"When Nataline died, so did any desire I had to continue to work for an industry that I came to realize was getting between people and their doctors to that extent," Potter said.

Potter has testified before Congress about his concerns with a health insurance industry that makes increasing shareholder profits its top priority.

Critics contend that the KanCare process is moving too fast and say including long-term care of developmentally disabled people in managed care contracts has not been successful elsewhere. The House and Senate are considering resolutions asking that the contracts be delayed six months.

A House committee also is hearing a bill by Rep. Jim Ward, D-Wichita, that would exclude long-term care of the developmentally disabled from the plan. And the governor's office announced Monday that Brownback had written an amendment to increase his proposed budget by $1 million to educate patients and providers on the KanCare transition.

"I think what you're seeing is a reflection that the concerns of thousands of people still mean something," said Tom Laing, executive director of Interhab in Topeka, which hosted Potter's address. "Both to the administration and the Legislature."

Before Potter spoke Tuesday, Laing read a statement signed by Colyer and Department on Aging Secretary Shawn Sullivan that thanked the advocates for their work and the "meaningful dialogue" with the administration.

"We remain committed to providing integrated care and better outcomes to the Kansans who will be served," the statement read. "We believe that with state oversight, contractual protection and private-sector resources, we can better coordinate and manage all services."

In testimony before the Senate Public Health and Welfare Committee, Potter told legislators that several of the companies bidding on the KanCare contracts have raised concern from state and federal regulators and the American Medical Association.

He encouraged lawmakers to ask whether the companies bidding on KanCare have the staff and resources to implement it, along with asking about their patients' satisfaction in other states, what percentage of their revenue is used to pay medical claims, and why Blue Cross and Blue Shield — the state's largest insurer — declined to bid on the plan.

Len Nichols, director of the Center for Health Policy Research and Ethics at George Mason University, talks about the federal health reform during a program Sunday, March 11, 2012, at Plymouth Congregational Church, 925 Vt. He said enactment of the Affordable Care Act is far from over and encouraged residents to become actively engaged in the process of improving the health care system. by Karrey Britt

Len Nichols, a national expert in health care policy, said although the federal government passed and signed into law the Affordable Care Act two years ago, it is far from a done deal.

He believes the Supreme Court will not rule the entire bill as unconstitutional this summer, and therefore, its fate will be determined during this year’s presidential election. That’s when the bill could be erased or changed.

“We are divided as a nation. We’ve reached an impasse,” he said. “We will know a lot more in January than we do now.”

Nichols, director of the Center for Health Policy Research and Ethics at George Mason University, spoke about federal health reform Sunday afternoon during a 90-minute program at Plymouth Congregational Church in downtown Lawrence that was attended by about 100 people.

Nichols said the Affordable Care Act is about getting health costs under control and expanding health care access to the poor. It also gets rid of fee-for-service medicine and instead provides fundamental incentives.

“The misconception is that it’s a government takeover, but it’s not. It’s about transforming a system that’s not working,” he said. “It’s a moral thing and a cost thing.”

Doctor shortage

After Nichols briefly spoke, a panel of five local health experts weighed in. Among them was Lawrence Memorial Hospital President and CEO Gene Meyer, who said there will be a shortage of primary care doctors to handle the approximately 10,000 newly insured patients in Douglas County in 2014 when the insurance mandate kicks in.

“Lower your expectations,” he said. “The ability to get in and receive the high quality health care that you’ve come to enjoy will be compromised by this law,” he said. “We do not have the provider system set up to handle that new bulk of folks who be using health care.”

Meyer said there are 2,000 pages of health reform, and LMH officials have spent a lot of time and money on figuring out to comply with those regulations. He said every new job that has been created at LMH during the past three years has been a compliance position instead of one that provides health care.

Additionally, he disagreed with Nichols on expanding access. He said everyone does have access to health care whether they have insurance or not, and that’s through the emergency room, where it’s most costly.

Nichols said that’s true and added that the government basically has told hospitals to take care of the poor for a little bit of money. “Then, we ask them to make it up anyway they can — wink, wink,” he said. “Hospitals charge private payers more because they have to. Gene’s a nice guy, but he’s not an ATM machine.”

Lawrence Memorial Hospital CEO and President Gene Meyer talks about his concerns regarding the Affordable Care Act during a panel discussion Sunday, March 11, 2012, at Plymouth Congregational Church. Among his concerns: a shortage of doctors to take care of the newly-insured population. Others on the panel were, from left, Dr. Donald Hatton, Jamie Simpson, Marci Nielsen, and David Johnson. by Karrey Britt

Change delivery system

Marci Nielsen, executive director of the Patient Centered Primary Care Collaborative in Washington, D.C., and former executive director of the Kansas Health Policy Authority, said there are provisions in the Affordable Care Act to address the physician shortage. She said one way is to focus on a patient-centered medical home where pharmacists, therapists, nurses and mental health professionals are engaged in providing care — not just doctors. “What we’ve got to do is change the way we deliver services,” she said.

Nielsen said the Affordable Care Act has become more controversial since it was passed. “It’s incredibly complicated and continues to be controversial for reasons that are more political than of substance,” she said.

She said a number of groups supported the bill when it was passed and continue to support it — nurses, pharmacists, hospitals and doctors. For the first time in 100 years, she said the American Medical Association supported national health reform.

Marci Nielsen, executive director of the Patient Centered Primary Care Collaborative in Washington D.C., discusses federal health reform during a program, "Health Care in the 21st Century," at Plymouth Congregational Church in downtown Lawrence. About 100 people attended the program. by Karrey Britt

Single-payer system?

During a question-and-answer session, someone asked why we couldn’t go to a single-payer system like other countries. Nichols said he had a better shot of making the Kansas University basketball team. He said the problem is no one trusts the government.

Ironically, Nielsen added, people like the Medicare system, and it receives a higher satisfaction rate in surveys than other insurance plans. She said during 57 town hall meetings, she heard time and again how much Kansans liked Medicare.

“Medicare is government health care,” she said in a whisper, which caused laughter from the audience. “Don’t tell any one.”

Affordability?

Laura Nash, a part-time nurse, said her employer didn’t offer health insurance, and she couldn’t afford it on her salary. She wondered how the Affordable Care Act would help her.

Nichols said the Medicaid system would be expanded to include more low-income Americans. If she made too much to qualify for Medicaid, then she would be able to buy insurance through a new marketplace called an exchange. The cost of the insurance plan will be tied to income.

“It’s designed to be affordable,” he said. “Having said that, I can’t guarantee it’s going to feel affordable when it comes time for you to pay what you have to pay.”

Meyer added that he also worries there will not be enough doctors who will take the new insurance plan or Medicaid. He said there aren’t enough doctors accepting Medicaid now.

Nielsen said safety net clinics like Health Care Access and Heartland Community Health Center will continue to play a role in providing care. She said the Affordable Care Act added $11 billion for such centers.

Among the other panelists were Jamie Simpson, former disability program coordinator for the Kansas Department of Health and Environment; David Johnson, CEO of Bert Nash Community Mental Health Center; and Dr. Donald Hatton, of Reed Medical Group and a regent for the American College of Physicians.

Nichols concluded by encouraging everyone to participate in health reform.

“If you sit back and watch this being done to you. I promise you, you will not like it,” he said. “If you want to make this better, tell the truth and use your faith to keep the conversation going.”

Len Nichols, a nationally-renowned expert on health care policy, answers a question from the audience during a program on federal health reform Sunday, March 11, 2012, at Plymouth Congregational Church, 925 Vt. Nichols is director of the Center for Health Policy Research and Ethics and a professor of health policy at George Mason University. by Karrey Britt

TOPEKA — A group of veteran legislators on Wednesday crossed political and ideological lines to urge Gov. Sam Brownback to slow down his push to privatize Medicaid.

But the Brownback administration rejected the plea. "It would be a costly mistake to postpone making these critical improvements to our system," said Lt. Gov. Jeff Colyer.

State Sen. Dick Kelsey, R-Goddard, disagreed. "Medicaid is a massive and complex issue. By rushing through the implementation process, the livelihood of more than 380,000 Kansans who rely on Medicaid services will be threatened," Kelsey said.

Kelsey was joined by other Republicans and Democrats in support of a resolution to delay implementation of the Medicaid overhaul from January to July 1, 2013.

The six-month delay will give legislators another legislative session to analyze the plan to ensure that providers meet the needs of Medicaid recipients "without causing interruptions or delays in services," Kelsey said.

Brownback, a Republican, has proposed converting the $2.8 billion federally and state funded program to a managed care system handled by private insurance companies. Brownback has said the new system, which will be called KanCare, will have incentives to reduce costs and improve the health of those treated.

The bipartisan group of legislators said other states, in turning over Medicaid to managed care companies, have experienced major problems, such as providing late payments to health care providers and conflicts over what services and medications are covered. They also said more alarms were raised in Kansas when Blue Cross Blue Shield of Kansas, the state's largest insurance company, declined to bid on the KanCare contract. Blue Cross said the contract "would have required us to dramatically change our business model to serve new populations in different settings in less than a year."

Twenty-two of the Senate's 40 members have signed on to the resolution seeking a delay, while about 40, or less than one-third of the 125-member House have signed on.

State Rep. Jerry Henry, D-Cummings, said more House members will sign up in the coming days.

Henry said he was concerned how the proposed system would impact rural Kansas, nursing homes, and pharmacies. "There are a lot of issues that need to be addressed before this can happen," he said.

Another major issue is including contracts for people with developmental disabilities. Advocates say the long-term supports needed for people with developmental disabilities don’t fit with a private program to manage healthcare costs. And they said the governor’s plan doesn’t address the nearly 5,000 people with developmental disabilities on a waiting list to receive assistance in their homes.

The resolution also states that a six-month delay would give policymakers time to determine how any U.S. Supreme Court ruling on the Patient Protection and Affordable Health Care Act would impact the implementation of KanCare.

But Colyer, Brownback's point man on Medicaid, said the administration is drawing from the best examples from other states and will be able to avoid problems experienced elsewhere.

"We have undertaken this reform slowly but surely," Colyer said. "Delaying KanCare will only guarantee continued cost increases, put providers at risk of rate cuts, and threaten the quality of care being provided to vulnerable Kansans. The status quo is not serving us well, and delay will not improve the health of anyone," he added.

Colyer, who is a physician, said he will soon announce a KanCare advisory panel that will include representatives from mental health, substance abuse, disabilities, doctors, hospitals, pharmacists, seniors, tribal organizations, family members, legislators and consumers.

By John Hanna, Associated Press

TOPEKA, Kan. — Gov. Sam Brownback's administration expects to decide this summer which private companies will manage the $2.9 billion Medicaid program in Kansas.

Lt. Gov. Jeff Colyer, who led the team that developed Brownback's plan to overhaul the program, also told legislators on Monday that companies have shown "vigorous" interest in the contracts. Medicaid provides health coverage for the poor, disabled and elderly.

Brownback had a dinner for a bipartisan group of two dozen legislators at his official residence, and both he and Colyer made remarks on policy issues. The governor permitted an Associated Press reporter and photographer to observe the gathering.

Brownback's administration plans to issue three contracts this year for the Medicaid program. Each contract would start, Jan. 1, 2013, and each company would operate statewide, so that Medicaid clients would have a choice of coverage.

The overhaul represents the first time the state has attempted to cover the disabled and the elderly, including those in nursing homes, with a managed-care program.

"It takes several months," Colyer told the legislators. "It'll be this summer."

Potential contractors had until Jan. 31 to submit the technical details of their proposals to the state, and they have until Feb. 22 to submit the rest of their materials.

Fifteen companies qualified to bid by attending a mandatory state conference for potential contractors in December, but one, Blue Cross and Blue Shield of Kansas Inc., the state's largest health insurance company, has since announced that it will not submit a proposal.

The Department of Administration declined a request from The Associated Press for a list of the remaining potential bidders, citing provisions of the Kansas Open Records Act that allow government agencies to keep confidential data "in the process of analysis" and records related to sealed bids.

But Colyer said "multiple organizations" are pursuing the contracts.

"That's a real positive," he said.

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. By bringing the disabled and elderly into a managed-care system, the state would add Kansans who need relatively expensive long-term services.

Administration officials have said the overhaul will lead to better coordination of services for high-need Medicaid participants and will eliminate duplication.

But some legislators and advocates, particularly for the disabled, have worried that the state is moving too quickly to overhaul the Medicaid program.

"I'm hearing from more and more stakeholders about how things are proceeding," House Minority Leader Paul Davis, a Lawrence Democrat, said after Monday evening's meeting, which he attended.

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.

By Scott Rothschild

KanCare_sullivan.jpg

TOPEKA -- Backed by advocates for Kansans with developmental disabilities, a Republican legislator on Monday urged Gov. Sam Brownback to delay his proposal to privatize Medicaid.

Sen. Dick Kelsey, R-Goddard, joined a chorus of comments that the move toward managed care was going too fast and had too many unresolved issues.

He noted the request for proposals from managed care companies elicited 1,100 questions from the bidders. “Even the professionals don’t understand what is being suggested, let alone the providers of Medicaid services and those receiving those services,” Kelsey said.

Matt Fletcher, associate executive director of InterHab, called Brownback’s proposed KanCare system an “unproven, untested and unwarranted gamble.”

Sharon Spratt, chief executive officer of Cottonwood Inc. in Lawrence, urged state officials to slow the process. “This is really too fast of a push to put everything into managed care,” she said.

And Chad VonAhnen, director of the Sedgwick County Developmental Disability Organization, said he has been contacted by many parents who fear that after they are deceased, their child will face a for-profit insurance company to receive long-term assistance and supports.

Brownback, a Republican, has proposed privatizing the Medicaid system, which serves approximately 350,000 Kansans.

The most controversial aspect of the plan is including contracts for people with developmental disabilities. Advocates say the long-term supports needed for people with developmental disabilities don’t fit with a private program to manage healthcare costs. And they said the governor’s plan doesn’t address the nearly 5,000 people with developmental disabilities on a waiting list to receive assistance in their homes.

Brownback administration officials at the Senate Public Health and Welfare Committee meeting sought to allay the fears of advocates and legislators.

Shawn Sullivan, secretary of the Kansas Department on Aging, said the administration’s intent is to use the community providers as they are now for at least the three-year life of the proposed contracts.

After hearing Sullivan’s remarks, Spratt said she has heard conflicting opinions coming from the administration on this issue.

Kelsey said he would like to delay implementation of the KanCare program for six months, until July 1, 2013. The current implementation date is Jan. 1, 2013. He said he also would like to remove people with developmental disabilities from the KanCare proposal.

Sen. Laura Kelly, D-Topeka, said the overhaul of the Medicaid system is “almost guaranteed to fall on its face.” She said she would prefer that any changes to Medicaid be phased in over time.

TOPEKA - Kansas ranked last in the nation in making progress in insuring children, a new study says.

Nationally, the number of children without health insurance coverage decreased from 2008-2010.

But Kansas and Minnesota went in the opposite direction.

The two states had the highest percentage increase of uninsured children during that three-year period, according to the study conducted by the Georgetown University Health Policy Institute's Center for Children and Families.

Kansas' rate of uninsured children in 2010 was 8.2 percent, up from 7.4 percent in 2008. That represents an increase of uninsured children of 7,853 from 51,930 in 2008 to 59,783 in 2010.

Over the same period, even with more children living in poverty, the nationwide rate of uninsured children decreased from 9.3 percent to 8 percent, which meant there were nearly 1 million more children insured. Thirty-three states and the District of Columbia experienced a decrease in the uninsured rate of children.

The improvement was attributed to more children getting coverage through states' Medicaid and Children's Health Insurance Programs.

So why did Kansas rank at the bottom?

Shannon Cotsoradis, president and chief executive officer of Kansas Action for Children, said Monday it was because Kansas' efforts to provide health care coverage for more children from low-income families were made later than most other states.

An expansion of eligibility and changes in procedures to make it easier to sign up for Medicaid and HealthWave were not fully implemented until 2010.

"We took some steps in the right direction," she said. "We are not seeing the fruits of those labors yet. We need to stay the course."

She added, “KAC has launched a statewide campaign to enroll more children in HealthWave, a program that provides quality, cost-effective health insurance to parents who can’t get or can’t afford private health insurance. Many kids in Kansas are eligible for HealthWave, but their parents may not know it. We aim to change that.”

Joan Aker, co-executive director of the Georgetown Center for Children and Families, said Kansas can learn from other states to reduce the rate of uninsured children.

"No matter where they live, families that are struggling to meet their children’s health care needs during perilous economic times should get the help they need. Overall, on a national level, these data highlight a rare piece of good news at a challenging time for children – poverty has gone up, but across the county more kids are insured," Aker said.

Because of high unemployment rates and increasing cost of private insurance, more families have applied for coverage under Medicaid and Children's Health Insurance Programs. President Barack Obama signed an extension of CHIP and earmarked $87 billion to the states in economic stimulus to help pay for Medicaid.

About 200 people attended a public forum about Medicaid reform in Dodge City. Rep. Steve Alford (R-Ulysses, lower center) addresses SRS secretary Rob Siedlecki (right, red tie) during one of the 15-minute roundtable discussions. by kbritt

Lt. Gov. Jeff Colyer announced Friday that the final public meeting on Medicaid reform would be Aug. 17. It will be from 1 p.m. to 5 p.m. at the Overland Park Convention Center Exhibit Hall.

State leaders are looking to cut at least $200 million from the Medicaid program while improving services.

They have held public forums this summer in Topeka, Wichita and Dodge City seeking ideas on how to achieve that goal. The forums were attended by more than 1,000 people.

“Moving forward, it’s my hope in Overland Park we can drill down into the details and receive more feedback on some of the ideas that were developed in the previous public meetings,” Colyer said.

The state pays about $1.1 billion of the $2.8 billion Medicaid price tag. There are 324,000 beneficiaries, which includes children, pregnant women and people with disabilities. There are 8,104 Medicaid recipients in Douglas County.

To reserve a spot at the forum in Overland Park, e-mail rsvp@ks.gov or contact Alisha Kirby at (785) 296-2213.

Amanda Reichard studies the state's Medicaid claims data as part of her research at Kansas University's Research and Training Center on Measurement and Interdependence in Community Living.

Better access to preventive health services and screenings for people with disabilities could shrink the $2.8 billion pricetag of the state’s Medicaid program, according to a Kansas University researcher.

That’s because those services could prevent more costly chronic conditions such as diabetes, heart disease, asthma and stroke.

Amanda Reichard has been analyzing Medicaid claims data for about 12 years. She started as a policy analyst for Medicaid, and now she works at KU’s Research and Training Center on Measurement and Interdependence in Community Living.

“For too long, we have associated poor health with disability and those words are not synonymous,” she said. “We know that people with disabilities experience chronic conditions as a health disparity — different from the general population. So, they are experiencing chronic conditions at higher rates than other segments of the population.”

Reichard said this is occurring for several reasons:

• There are facility and structural barriers.

• Health professionals lack training in providing care for people with disabilities.

An example would be the hurdles a woman with a physical disability might encounter in getting a mammogram. The equipment may not adjust for someone who needs to sit or the technician may not know how to adjust the equipment. Also, doorways to a dressing room or machine may not be large enough for a wheelchair.

“Understanding the unique needs of people with disabilities is really important,” Reichard said.

She has found a lot of hospitalizations that could have been prevented by getting a vaccine. She said Medicaid covers the immunizations but people with disabilities are not getting them, likely because the shots aren’t accessible.

• Medicaid doesn’t cover preventive services such as diabetes education, a fitness expert or a dietitian’s services. Reichard said the long-term savings could far outweigh any upfront costs.

She found that more than 70 percent of Medicaid recipients with physical disabilities are overweight and at a high risk for diabetes.

“I think addressing obesity is big issue because so many chronic conditions are related to obesity,” she said.

Reichard talked about a pilot project at KU that has so far proven to be successful. She said a woman with physical disabilities has lost 40 pounds, thanks to a dietitian who meets with the woman monthly. As a result of the weight loss, she can now reposition herself in bed, which means she doesn’t have to pay someone to do it and it helps prevent her from getting ulcers.

Also, the woman is not having as severe of leg cramps as before, and she’s getting out in the community more.

“So, it’s not only affecting her quality of life, but it’s also affecting her health overall and keeping her out of the hospital setting and potentially a nursing home setting,” Reichard said.

She shared her findings with the Kansas Department of Environment and Health, which administers the Medicaid program.

“We don’t really want this research to rest in the ivory tower,” she said. “We always seek to work with our partners at the Kansas Department of Health and Environment to make sure we translate our research into something that makes a real difference in the lives of people with disabilities.”

Cutting Medicaid costs

State leaders are looking to cut at least $200 million from the Medicaid program by July 1, 2012, for fiscal 2013, said Barbara Hersh, public information officer for KDHE. The state pays about $1.1 billion of the $2.8 billion pricetag. They also want to enhance care for the 324,000 beneficiaries, which includes children, pregnant women and people with disabilities. There are 8,104 Medicaid recipients in Douglas County.

During the past month, there were three public meetings throughout the state that drew more than 1,000 people and their ideas on how to do achieve that goal.

Hersh said there will be a final community meeting in early August in Kansas City, where a culmination of the ideas will be discussed.

“That’s where we will bring all of the ideas that we’ve gotten — maybe we will have a Top 10 list, and talk about how can we implement them,” she said. “It will give Kansans another chance to weigh in on how we can do this.”

The state’s Medicaid agency is now part of the Kansas Department of Health and Environment.

On Friday, the Kansas Health Policy Authority became the Division of Health Care Finance under KDHE. The merger was achieved through an executive reorganization order designed to save more than $1 million the first fiscal year.

Since 2005, KHPA served as the state’s Medicaid agency by administering the medical portion of the Kansas Medicaid program, as well as the state Children’s Health Insurance Program; MediKan, which provides coverage for certain low-income, disabled Kansans; the State Employee Health Program; and the State Self-Insurance Fund, which provides workers compensation coverage to state employees.

KHPA Executive Director Andy Allison will serve as director of Health Care Finance.

With about 220 KHPA staff members joining KDHE, the agency now employs about 1,100.

President Barack Obama gestures during a news conference Wednesday, June 29, 2011, in the East Room of the White House in Washington.

The budget debate is heating up in Washington.

President Obama said in a news conference today that he wants Congress to “get it done,” to reach an agreement on deficit reduction by the end of the week. But Republicans in Congress have been insistent in recent days that any deficit reduction be limited to spending cuts, including reductions in benefit programs such as Medicare and Medicaid, and exclude additional revenues.

If the House Republican budget is implemented, Kansas would lose $91 million in 2013 to provide health care for low-income residents, seniors, and people with disabilities through the Medicaid program.

It also would cost 1,600 jobs and $171 million in business activity.

“This is exactly the wrong time for Congress to cut a program that boosts the economy while also providing a boost to individuals and families facing hard economic times,” said Ron Pollack, executive director of Families USA.

The national health consumer organization released a report today that showed the economic impact of the budget proposal sponsored by Rep. Paul Ryan, R-Wis., and adopted by the House.

The proposal — supported by all of the Kansas representatives — calls for cuts in federal funding to state Medicaid programs of 5 percent in 2013, 15 percent in 2014, and 33 percent in 2021.

Costs for Kansas:

• 5 percent — $91 million in federal funding, 1,600 jobs, $171 million in business activity.

• 15 percent — $275 million in federal funding, 4,790 jobs, $515 million in business activity.

• 33 percent — $605 million in federal funding, 10,540 jobs, $1.1 billion in business activity.

To put it in perspective, the state has a $13.8 billion budget.

Families USA report on federal Medicaid cuts. by kbritt

Pollack said the Medicaid cuts not only would damage the economy, but hurt seniors and people with disabilities and children who count on the program as their lifeline.

For example, two-thirds of people nationwide who are in nursing homes count on the Medicaid program as the primary payer.

About 324,000 Kansans and 8,104 Douglas County residents are enrolled in the Medicaid program.

— The Associated Press contributed information to this story.

An overhaul by Gov. Sam Brownback of the $2.8 billion taxpayer-funded Medicaid program is in the works.

On Monday, Brownback’s point man on the effort, Lt. Gov. Jeff Colyer, announced there will be three public forums on Medicaid, the first being next week in Topeka.

“It is essential to Governor Brownback and me that we receive guidance from Kansans while we work to reform our state’s Medicaid system,” Colyer said.

“These forums will provide Kansans from across the state the opportunity to give their input about health care in their communities. We look forward to working collaboratively with our fellow Kansans to find Kansas solutions for Kansas health care needs,” he said.

Medicaid is the federal-state funded program that provides health and long-term care services to several groups of low-income Kansans, including children, pregnant women, families, the elderly and those with disabilities.

The number of people served by Medicaid in Kansas has increased approximately 33 percent in the past decade to more than 300,000, or 12 percent of the state’s population.

Colyer is leading a Medicaid working group that includes Kansas Department on Aging Secretary Shawn Sullivan, Kansas Department of Social and Rehabilitation Services Secretary Rob Siedlecki, Kansas Department of Health and Environment Secretary Robert Moser, Budget Director Steve Anderson, and Kansas Health Policy Authority Director Andy Allison.

Moser, a physician, said the administration wants to make Medicaid more effective.

“This effort is not just about cost savings. The ability to more effectively purchase and administer health care builds a better Kansas with stronger families and a growing economy,” Moser said.

The meetings will be in Topeka on June 22, in Wichita on July 7 and in Dodge City on July 8.

The Medicaid working group will launch within a few weeks a web-based tool for Kansans to submit comments and ideas. A final conference will take place in August.

The forums and consultation process are being funded by the Health Care Foundation of Greater Kansas City, the Kansas Health Foundation, the REACH Healthcare Foundation, the Sunflower Foundation, and the United Methodist Health Ministry Fund.

— Statehouse reporter Scott Rothschild can be reached at 785-423-0668.

Medicaid forums

Topeka: Wednesday, June 22, from 1:30 p.m. to 4:30 p.m. at the Kansas Expocentre, Maner Conference Center.

Wichita: Thursday, July 7, from 1:30 p.m. to 4:30 p.m. at a location to be announced.

Dodge City: Friday, July 8, from 9 a.m. to noon at the United Wireless Arena, Magouirk Conference Center

Because of limited seating, the governor’s office has requested those wanting to attend to sign up on one of the following links:

Topeka: https://www.dhe.state.ks.us/Community/se.ashx?s=11B9BDC92B72B9B6

Wichita: https://www.dhe.state.ks.us/Community/se.ashx?s=11B9BDC93E4CE00F

Dodge City: https://www.dhe.state.ks.us/Community/se.ashx?s=11B9BDC91E57F2FF

People can also RSVP by contacting Alisha Kirby in the lieutenant governor’s office at (785) 296-2213 or by emailing rsvp@ks.gov. Please indicate which meeting by including the name of the city in the subject line.

Families USA website by kbritt

The House Republicans’ plan to repeal the 2010 federal health law and convert Medicaid into a block grant program -- put together by House Budget Chairman Paul Ryan, R-Wis. -- passed the House last month in a vote along partisan lines. A report released today shows how the cuts could have a devastating impact on seniors and people with disabilities across the United States, including Kansas. Another study released Wednesday showed that states would lose an average of 34 percent of their federal funding for Medicaid.

Today's report by Families USA, a consumer health organization, shows that 6 million seniors and 9 million people with disabilities receive health coverage through the Medicaid program.

Ron Pollack, Families USA executive director, said the cuts also would affect the 52 million caregivers — spouses, children and friends — who provide care on an informal basis.

“These people would be significantly impacted if the Medicaid program were cut back and services were reduced for people needing long-term care because many of them would need to leave their jobs in order to provide full-time care for their loved one,” Pollack said.

Pollack said Medicaid is the main funding source for long-term care, such as nursing homes and home health. He said 63 percent of nursing home residents receive coverage through Medicaid.

“The Congressional Republicans voting to cut back Medicaid are doing a great disservice to our nation’s seniors and people with disabilities as well as their families,” Pollack said. “This is the essence of anti-family budgeting and we hope that these ill-conceived proposals will be reconsidered.”

Here’s a look at Medicaid in Kansas:

• 37,600 — seniors on program.

• 71,600 — people with disabilities on program.

• 53 — percent of seniors who rely on Medicaid for nursing home care.

• $52,600 — average annual nursing home cost.

• 31,000 — people receive home health care and are able to stay out of a nursing home.

• 410,000 — caregivers, many of whom are able to hold jobs, take care of families and simply rest because of Medicare services.

Wednesday's report was released by the Kaiser Family Foundation's Commission on Medicaid and the Uninsured, and conducted by researchers at the Urban Institute. In a review of the report, Phil Galewitz, a Kaiser Health News reporter, noted:

States that currently have the tightest Medicaid income eligibility rules and the highest proportion of poor people would gain the most under the Medicaid expansion in the federal health overhaul, and they would be the biggest losers under the Ryan plan, the report said. Under the health law, 16 million additional Americans would be expected to join Medicaid starting in 2014. Medicaid today covers about 50 million low-income Americans, mostly children and pregnant women. It also covers millions of poor people in nursing homes.

As a result of the cuts in funding in the Ryan plan, the Kaiser analysis estimates that between 31 million and 44 million fewer people would be enrolled in Medicaid in the next decade. Most would be left without insurance coverage.

A comparison of three proposed Medicaid funding plans: Affordable Care Act (ACA), ACA repeal, and the House budget plan. by jestevens

For more information about Medicaid -- who it funds, how it works, check out the Families USA Medicaid section.

The Community Health Center of Southeast Kansas in Pittsburg serves about 22,000 people. It provides mental, dental and medical health services inside the building, along with a pharmacy. The center also serves as the repository for the state's unused medication program. by Kevin Anderson

Pittsburg — A Community Health Center in this small southeastern Kansas town of 20,000 is garnering national attention.

That’s because it provides care for anyone regardless of their income or insurance, and it is doing it successfully. Its growth is off the charts, and it has come during the worst economy in decades.

When it was founded in 2003, the center had 3,300 patients, 6,600 patient visits and a $1.3 million budget. Last year, it had 21,300 patients, 70,300 patient visits and a $9.3 million budget.

It went from 15 full-time employees to 135, the majority of which hold good-paying jobs like doctors, psychiatrists, dentists and nurse practitioners.

Mark Turnbull, director of economic development in Pittsburg, said the center has helped the economy. More importantly, it has provided critical medical services for a very low-income population, especially at a time when many residents have suffered pay cuts or layoffs. The average per capita income in Crawford County is $29,900, about $10,000 less than the state average.

“It has been a very big help to families,” Turnbull said.

The clinic also serves residents in nearby Oklahoma and Missouri as well as others who drive 150 miles for care when they have no place left to turn.

“It’s not like poverty or the need for care stops at the state line,” said Jason Wesco, chief operating officer. “We just don’t turn people away.”

Jason Wesco is chief operating officer at the Community Health Center of Southeast Kansas in Pittsburg. He was executive director of the Douglas County Dental Clinic from 2003 to 2005. by Kevin Anderson

The Community Health Center of Southeast Kansas has helped the economy in Pittsburg, a town located about 140 miles southeast of Lawrence. This is a picture of the downtown area. by Kevin Anderson

The patient waiting room at the Community Health Center of Southeast Kansas in Pittsburg. by Kevin Anderson

Integrated care

The Community Health Center of Southeast Kansas, commonly called CHC/SEK, is unique in that it provides more than just medical care in its 15,000-square-foot building, which is located just a few blocks from the town’s main street.

It also offers dental and mental health services along with a lawyer, patient care navigator and pharmacy. Providers and patients enjoy the integrated system.

While sitting in the waiting room, Michelle Mitchell, of Arma, said her family has used the center for its medical, mental health and pharmacy services.

“We’ve done about everything here,” she said. “It’s convenient. It’s easy to use.”

Mitchell has private insurance and her 12-year-old son, Richard Brown, is on a Children’s Mercy Hospital health plan. But, Mitchell said she used the center when she was uninsured.

“It doesn’t matter whether you have insurance or whether you can pay at the time or not,” she said. “They send you a bill and you pay what you can, when you can, and they don’t harass you about it.”

There’s also no wait. Her son had an asthma attack in the morning and she was able to get an appointment with a pediatrician right away.

“This is great,” she said of the center.

Michelle Mitchell checks the fingernail color of her son, Richard Brown, 12, while they waited for a doctor to see them in an exam room. An asthma attack prompted the visit to the Community Health Center of Southeast Kansas in Pittsburg. The family lives in Arma, Kansas, about 10 miles away. by Kevin Anderson

Pharmacist Ken Wood and Alicia Norton fill prescriptions for patients at the Community Health Center of Southeast Kansas in Pittsburg. The on-site pharmacy helps create a one-stop shop for patients. by Kevin Anderson

‘Job is easier’

Cheryl Rajotte, family nurse practitioner, has worked in the Community Health Center since it provided only medical care and she was the only one providing it.

She had to call community doctors for help. Some were receptive, others weren’t.

Back then, she had no relationships with dentists or psychiatrists. If someone had a toothache, she couldn’t do anything but say, “Go to the dentist.”

That’s different now.

“My job is a lot easier because I have resources within my building,” Rajotte said. “I have patient consults with internal medicine doctors, pediatrics, dentists, pharmacists — all within a phone call or walk down the hallway.”

She remembers when the clinic got its start and the private health sector was concerned about the center stealing patients. She knew better.

Rajotte was the town hospital’s emergency room director before helping start the Community Health Center. She saw the patients who were coming into the ER. Many just couldn’t afford care.

“They were getting episodic, most-expensive type care,” she said. “Now, they have a medical home and we can coordinate their care.”

Nurse practitioner Cheryl Rajotte, left, goes over patient information with administration assistant Maggie Serrano at the Community Health Center of Southeast Kansas in Pittsburg. by Kevin Anderson

Patient navigator Julie Laverack is available to answer patients' questions at the Community Health Center of Southeast Kansas in Pittsburg. by Kevin Anderson

Beyond basic services

The clinic has an internal medicine doctor, two pediatricians and two family medicine doctors on its staff. Specialists in cardiology, orthopedics and podiatry, provide care at the center on a part-time basis.

The center has three chairs in its dental clinic and it offers everything from crowns and root canals to fillings and extractions.

Dr. Patrick Lancaster said he had a patient who was on seizure medicine that caused her gums to grow over her teeth. She switched medications and then they fixed her teeth.

“She’s smiling again and going for job interviews,” he said.

“That’s where we fill a huge gap — being able to provide the sliding fee scale, so if somebody wants to take care of their teeth and couldn’t afford it elsewhere, they could do it here,” Lancaster said.

The center also provides dental services, from fillings to varnishes, in 33 school districts. Last year, it provided dental screenings for 30,000 students.

In the mental health area, they offer counseling, testing and medication management. There are four psychiatrists and one clinical social worker and they see about 65 patients per day.

Dr. Darwin Anderson, psychologist, said he has about 1,500 clients. Illnesses range from depression and anxiety to schizophrenia and childhood disorders.

The center also has a part-time attorney who has 60 open cases. She helps patients with anything from divorce to housing issues.

And there is a patient navigator who meets with patients during their first visit to go over the services and answer questions.

The Community Health Center has four small clinics that offer one or two services:

• Downtown Pittsburg — dental.

• Baxter Springs — dental and medical.

• Iola — dental.

• Columbus — dental, medical and pharmaceutical.

Wesco said the center has applied for a grant to open a clinic in Coffeyville. He also believes there is a need for affordable care in Chanute, Parsons and Fort Scott.

“A lot of it will depend on the communities,” he said. “We never go anywhere that we are not invited. It’s hard enough to do the work; we don’t need to face opposition as well.”

Shawn Bruce, 21, and Kasey Fowler, 23, brought their 11-month-old daughter Anabella Bruce-Fowler to the Community Health Center of Southeast Kansas in Pittsburg because she was not feeling well. The family lives in Girard, about 15 miles away. by Kevin Anderson

Dental hygienist Alie Harper cleans the teeth of 4-year-old Tyler Wycough at the Community Health Center of Southeast Kansas in Pittsburg. by Kevin Anderson

Dental hygienist Alie Harper gets 4-year-old Tyler Wycough ready for X-rays Wednesday, April 27, 2011, at the Community Health Center of Southeast Kansas in Pittsburg. by Kevin Anderson

Keys to success

The Community Health Center is governed by a 15-member board that includes patients and community representatives.

Its $9.3 million budget comes from grants, donations and patient services. The breakdown:

• 20 percent — federal grants.

• 6 percent — state grants.

• 6 percent — private foundation grants and contributions from individuals and businesses.

• 68 percent — patient services. This includes reimbursement for Medicaid, Medicare, private insurance and reduced fees for services. CHC/SEK is a Federally Qualified Health Center, which means it gets cost-based reimbursement for its Medicaid services. In return, it has to follow federal guidelines.

“Our goal is to provide good quality health care primarily to the people who don’t always have it,” Wesco said. “We try to make it affordable so people will use us. We don’t want to create a financial barrier.”

He said the center has been successful because there is a great need for its services. Not only is the area financially poor, but itss health is too. Crawford County ranks among the 10 least healthy counties in Kansas.

Wesco also credits the staff.

“We work very hard to run a tight ship and to be as efficient as possible,” he said.

Hope for Heartland

Jon Stewart, CEO of Heartland Community Health Center in Lawrence, toured the Southeast Kansas center in February.

“They’ve done some incredible things with that program and it certainly is an inspiration to us. I see an awful lot of potential through that program,” he said.

Heartland also provides care regardless of a person’s ability to pay or whether she/he has insurance. It offers counseling and a food pantry, and it has applied to become a FQHC center, which would bring in hundreds of thousands of dollars in federal funding.

With the funding, Heartland would provide dental services and more.

“The whole goal has been to provide these kinds of services and have it happen in a very integrated, coordinated way, and really try to meet needs,” Stewart said.

CHC/SEK has become the place of choice for its patients, instead of the place of last resort. That’s what impresses Stewart the most.

“Certainly, that is what we want to be viewed as,” he said. “The place that is doing business and doing health care really, really well.”

BY THE NUMBERS

Here’s a look at the Community Health Center of Southeast Kansas in Pittsburg and its four area clinics:

• $9.3 million budget

• 135 — full-time staff members

• 7 — doctors

• 5 — dentists

• 1 — psychiatrist

• 4 — psychologists

• 8 — dental hygienists

• 8 — nurse practitioners

• 1 — clinical social worker

• 25,000 — patients each year

• 70,300 — patient visits in 2010

• 360 — new patients each month

Here's a look at its patient demographics:

• 50 — percent are ages 19 and under.

• 46 — percent are between 20 and 65.

• 4 — percent are older than 65.

• 45 — percent are uninsured.

• 32 — percent are on Medicaid.

• 20 — percent have private insurance.

• 3 — percent are on Medicare.

• 80 — percent have an annual income that is 100 percent of the federal poverty level or below. That’s $10,890 for an individual or $22,350 for a family of four.

• 2 — percent earn above 200 percent of the federal poverty level. That’s $21,780 for an individual or $44,700 for a family of four.

Dr. John Listerman, left and Allison Veeder, ARNP, confer about a patient Wednesday, March 30, 2011, at Heartland Community Health Center. The center provides medical care for low-income residents. by Mike Yoder

Heartland Community Health Center is offering deeper discounts and accepting Medicaid in an effort to provide more affordable health care in the Lawrence community.

“Our goal is to make health care accessible. I think our previous fee of $30 was too much of a barrier for a lot of folks,” CEO Jon Stewart said.

Now, a patient earning $13,612 annually or less will pay $10 for a standard office visit, instead of $30. For a family of four to qualify, its combined income is $27,937 annually or less for a $10 visit. Those annual income figures are 125 percent of the federal poverty level.

Other fees are:

• $30 — for a patient earning between $13,613 and $21,780. For a family of four, it’s between $27,938 and $44,700.

• $70 — for a patient earning $27,781 or more. For a family of four, it’s $44,701 or more.

Stewart said the average cost for an office visit elsewhere is $95.

In 2010, Heartland — a safety net clinic located on the east end of the Riverfront Mall — served 1,200 patients. Of those, 68 percent fell below 100 percent of the federal poverty level. Only 4 percent were in the highest income level.

Heartland recently received approval to accept Medicaid as a form of insurance in addition to Medicare and some private insurance.

In April, there were 9,200 people on Medicaid in Douglas County, and there were 300 licensed Medicaid providers. These include physicians, mid-level practitioners, nurse practitioners, therapists, audiologists, podiatrists, chiropractors and optometrists. Although these providers are licensed, they may not accept Medicaid patients.

“We’ve received a lot of calls in the past from Medicaid patients who didn’t know where to turn. They were having trouble finding a provider,” Stewart said. “So, I certainly anticipate that we will help fill a need in the community.”

Heartland received a two-year $200,000 grant from the Sunflower Foundation of Topeka in November that has helped hire a nurse practitioner and social worker.

On March 1, Karin Denes-Collar, a licensed clinical social worker at Bert Nash Community Mental Health Center, began providing screenings and therapies alongside primary care providers. She works 20 hours a week now, but is expected to be working full-time in the next four to six weeks.

All of the recent changes are part of Heartland’s larger mission to provide an integrated medical home for patients — regardless of income or insurance.

It has applied to become a Federally Qualified Health Center. If approved, it would bring hundreds of thousands of dollars in federal funding to provide care. Stewart anticipates to learn whether it is accepted by Aug. 1.

At right, patient Don Hall, Lawrence, visits with AmeriCorps member Brittany Love, Conway Springs, center, and Kathleen Litton, advanced registered nurse practitioner, Friday, Oct. 1, 2010, at Heartland Medical Clinic. Heartland received a $117,000 grant to partner with the Corporation for National and Community Service to provide nine AmeriCorps members with training in the health care field. At left is Jack Campbell, a Kansas University student and volunteer at the clinic. by Mike Yoder

The Kansas Insurance Department received $31.5 million today to help design and implement the information technology infrastructure needed to operate a state health insurance exchange.

Kansas was among seven states chosen for an “early innovator” grant that was given by the Department of Health and Human Services.

“Early innovator states will play a critical role in developing a consumer-friendly marketplace where insurers must compete to deliver the best deal. These grants ensure that consumers in every state will be able to easily navigate their way through health insurance options.”

— HHS Secretary Kathleen Sebelius

Linda Sheppard, Patient Protection and Affordable Care Act project manager for the Kansas Insurance Department, said the grant will allow the department to work closely with the Kansas Health Policy Authority in creating a system that integrates Medicaid and health insurance information.

Ultimately, the new system will be able to determine whether Kansans are eligible for Medicaid or for subsidies that will help them pay for their insurance premiums if they get private insurance. It also will allow individuals and small businesses to compare plans and enroll in them.

She said they were able to snag the award because the KHPA already was working on a new Kansas Medicaid/CHIP eligibility system or K-MED. The innovator award allows them to move forward with integrating the Kansas Health Insurance Exchange.

“The timing worked out well for us,” Sheppard said.

Other “early innovator” states and their award amounts:

• Maryland Department of Health and Mental Hygiene, $6 million.

• University of Massachusetts Medical School, $35 million.

• New York Department of Health, $27 million.

• Oklahoma Health Care Authority, $54 million.

• Oregon Health Authority, $48 million.

• Wisconsin Department of Health Services, $37 million.

People wait for their number to be called at the Douglas County Dental Clinic in September 2009. A line formed early for the chance to receive free services, and all available 65 spots were filled by 7 a.m. by Kevin Anderson

One day each September, people start lining up outside the Douglas County Dental Clinic about 3 a.m. and wait for free care.

It’s called Free Dental Day, and low-income Douglas County residents are helped on a first-come, first-serve basis. Last year, 65 people received care thanks to volunteers, including seven dentists and Dr. Philip Gaus, an oral surgeon.

This Friday, Dr. Gaus and eight dentists will be volunteering.

“That’s fabulous. It’s more than we’ve ever had before,” Executive Director Julie Branstrom said. “But, that need exists beyond just Free Dental Day.”

The wait for an appointment has grown to six weeks. The clinic provides care for a fee, based on a sliding scale according to household income. It also accepts Medicaid.

“It would just be great if we had additional volunteers that were coming in and seeing more patients on a regular basis,” she said. “Our biggest need is that specialized skill of dentistry. It’s not like anybody can come in off the street and help us by providing dental care.”

The clinic has two full-time paid dentists and eight other full-time employees. Its funding comes from United Way of Douglas County, state grants and Medicaid reimbursements.

But, the clinic couldn’t provide the care it does without volunteers. It has about a dozen.

A few provide care regularly like Dr. S. Kirk Vincent, an oral surgeon. He has provided a free extraction once a week for years.

“That’s invaluable. We have so many patients that need an extraction and literally just can’t pay for it,” Branstrom said.

A handful of dentists will accept a referral on a case-by-case basis for things like a root canal or crown. Another handful of dentists volunteer occasionally to work in the clinic.

Dr. Ed Manda, of Cascade Dental Care, has been an active volunteer for the Douglas County Dental Clinic, 316 Maine. Manda provides care on Free Dental Day, and throughout the year in his office and at the clinic. The clinic could use more volunteers like him, as the wait for an appointment has grown to six weeks. by Kevin Anderson

Seeking change

Branstrom said getting dentists to volunteer has been a challenge.

“I really thought that when I came here a little more than five years ago, that I would have more success in getting volunteers to come on a regular basis, and it just really hasn’t turned out that way,” she said. “I am not really sure why, but I sure would like to see it change.”

A little help could make a big difference.

For example, she said, if eight dentists would volunteer one four-hour day, six times a year, the clinic would be able to offer an additional 208 patients visits.

If all 38 general Lawrence dentists volunteered that time, they could provide 912 patient visits. Last year, the clinic had about 6,000 visits.

Ed Manda, of Cascade Dental Care, volunteered before the clinic even opened in October 2001. He helped write grants to get the clinic started, has served on the board for years, and has cared for a lot of patients in his office and at the clinic, 316 Maine.

“He’s fabulous,” Branstrom said. “This clinic would not exist without Dr. Manda. He’s been involved from the very beginning and still is involved.”

Manda said he tries to help in any way possible.

“I have always liked what Winston Churchill said, ‘We make a living with what we get, but we make a life with what we give.’ And, I just think that’s helpful.”

The Douglas County Dental Clinic offered free dental care to more than 60 patients on Sept. 25, 2009. Dr. Ed Manda, left, and dental hygienist Michele Ritzman worked together on Edna Butler, who came in with a broken tooth. by Kevin Anderson

Patient’s influence

He will be helping at Free Dental Day, along with Dr. Jim Otten — the newcomer.

Otten, who has been a Lawrence dentist for 25 years, has been volunteering about 120 hours a year at national schools and organizations, like the Pankey Institute, National Children’s Oral Health Foundation and Donated Dental Services.

“One of my patients that was on the Douglas County Dental Clinic board had asked me if I volunteered and I was rather embarrassed that I didn’t,” he said. “It was a nice reminder that I also should be considering things here close to home.”

He has contacted Branstrom and arranged some time to give back locally. Besides helping at dental day, he plans to volunteer six, four-hour days a year at the clinic.

“Right now, dental practices are getting less busy but dental clinics, free clinics and need-based clinics are getting busier and that has been a general trend.”

Otten said the rewards of his volunteer work are endless.

“Sometimes, it’s just a smile or a thank you,” he said. “Sometimes, it’s very emotional.”

He will never forget one woman he helped through Donated Dental Services, which has a Topeka office. She was out of work, had a mental disability and physical illness. Most of her teeth had been missing for years. He saved the half-dozen or so teeth that were left and put in partial dentures.

When he was done, she looked in the mirror at her smile and started to cry.

“For the first time, in probably dozens of years, she had teeth to chew on,” he said.

At the last appointment, she handed him a little package and said, “It’s not much, but I want to give you something because I haven’t felt this good in a long time.”

She had stitched his name — Dr. Otten — on fabric and put it in a small frame.

“What do you say? ‘If I died tomorrow, it’s OK, you know,’” Otten said. The frame sits in his home office.

Dr. Jim Otten

WANT TO HELP?

If you would like to learn more about Douglas County Dental Clinic or volunteer to help, contact Julie Branstrom, executive director, at 312-7770, extension 207, or e-mail dcdcdirector@sunflower.com. Its website is www.dcdclinic.org.

Coming Friday: Coverage of Free Dental Day and a look at how the clinic’s services have helped Douglas County residents.

Lawrence Memorial Hospital leaders are concerned federal health reform will exacerbate the shortage of primary care physicians in the Lawrence community and nationwide.

“If 32 million Americans eventually have some form of health insurance that had not and they start using it, where they are going to get that care is going to be a challenge if the delivery system is not in place,” said LMH President and CEO Gene Meyer.

The hospital released a report Wednesday morning during its Board of Trustees meeting about the possible impact of federal health reform.

About 45 LMH leaders have been researching and studying the legislation, and they believe primary care will take the biggest hit.

“Stresses on independent, freestanding physician practices will be greater in the future than they’ve ever been,” Meyer said.

He said reform will provide a slight increase in reimbursement rates for these doctors, but their costs are increasing at an even faster rate. These costs include implementing electronic medical records, malpractice insurance, staffing and processing insurance claims. Often, they are paying back student loans as well.

“That’s a real balancing act and one that many practices, that are the size of many practices in Lawrence, will be extremely economically challenged with,” Meyer said.

President and CEO of Lawrence Memorial Hospital Gene Meyer by Richard Gwin

About 50 physicians and nurse practitioners are affiliated with LMH. To help prepare for health reform, the hospital is stepping up its collaboration efforts with them.

In July, LMH created a new Physician Practice Division to bring all of the providers under the same management, which will allow for standardization across the practices. Sheryle D’Amico has been named vice president of physician services and will oversee the department.

“Physicians and hospitals have to work in tandem to be successful through what the proposed health care reform likely will bring,” D’Amico said. “Even if the reimbursement rates go up, there won’t be enough providers to manage all of these patients.”

Meyer said LMH, like other hospitals, is considering hiring nurse practitioners who can provide primary care, or hiring physician assistants who can provide care with oversight by a doctor.

Lawrence Memorial Hospital, 325 Maine.

Besides affecting primary care, LMH expects:

• Medicare reimbursement changes. The reimbursement rate will be used to penalize and reward hospitals, depending on quality and cost-effectiveness of care.

• Expansion of Medicaid eligibility. LMH estimates about 10,000 new patients as a result. Meyer is concerned about who will take care of this group because few doctors are accepting Medicaid patients now.

• Increased demand for emergency services due to lack of primary care physicians. This is costly for the hospital and consumers.

• More regulatory changes. They say there are many rules yet to be written and interpreted.

Meyer doesn’t expect to see any major effects of reform for about four years.

“I think the worst thing we could do is to overreact to something that we really aren’t quite sure how it’s going to develop,” Meyer said.

Congressman Jerry Moran stopped Thursday morning in Lawrence to learn about Health Care Access, a clinic that serves low-income, uninsured residents in Douglas County.

Moran, who is candidate for the U.S. Senate, was invited by clinic leaders. He spent about an hour at the clinic, 330 Maine, touring and asking questions about its operations, funding and relationships with other providers.

About a dozen people welcomed Moran, including several Health Care Access board members, Lawrence Memorial Hospital CEO Gene Meyer, State Rep. Tom Sloan, of Lawrence, and Connie Hubbell, director of governmental affairs for the Kansas Association for the Medically Underserved.

The association serves the state’s 39 safety net clinics, including Health Care Access. Hubbell said only six clinics provide free care like Lawrence’s clinic.

Moran said he was impressed that the clinic operates without federal dollars. Its annual budget is about $480,000. About half of the money comes from the city, county, state and United Way of Douglas County. The other half is from grants, fundraisers and donations.

Yet, the clinic provides $4 million worth of care each year, along with $450,000 in medication.

“What’s in a sense pleasing to me is that people here are asking for little from the federal government,” Moran said. “They are not requesting money because this really is a volunteer and private donor operated facility. It means the medical community in Lawrence is stepping forward to provide services, and it means they have volunteers and donors who are making this clinic possible.”

From left, Kansas Rep. Tom Sloan, Health Care Access board member Sheryle D'Amico, and Congressman Jerry Moran, listen to Nikki King, executive director of Health Care Access, talk about the clinic's work. Moran toured the clinic Thursday, Aug. 12, 2010. The clinic, located at 330 Maine, provides primary care for low-income, uninsured Douglas County residents. by Richard Gwin

During the tour, the potential effect of health care reform was on everyone’s mind.

The clinic serves about 1,400 residents annually. There are an estimated 17,000 people who are uninsured in Douglas County.

Moran said that while more people may become insured, he fears there won’t be enough health care providers, especially ones who will accept Medicaid and Medicare, which will be expanded to encompass the previously uninsured.

Moran, who serves as co-chairman of the House Rural Health Care Coalition, voted against the bill.

One of the main reasons, he said, was because it didn’t address the costs of health care.

“We ought to be addressing why does health care cost as much as it does, and we ought to be addressing the cost drivers, and this bill doesn’t do that,” he said.

He’s also concerned that the bill will reduce Medicare and Medicaid reimbursements to doctors and hospitals. He thinks the possible rate reduction will cause health providers to retire and college students to seek careers outside the medical field.

“We are adding one more segment of patients whose provider will be compensated at a rate less than what it costs to provide the service,” he said.

Moran said there are 75 hospitals in the 1st Congressional District that he now represents — the most of any congressional district in the country. He said their biggest challenges are Medicare and Medicaid reimbursement rates, health care provider shortages, and the red-tape paperwork that drives up costs.

He said “it’s hard to predict” how reform will affect these hospitals.

What he does know is that safety net clinics, like Health Care Access, are saving money.

“It’s cost-effective. One of the most expensive ways of providing health care is an emergency room and this is a way that we can provide quality service without that high price tag.”

At the end of the tour, Hubbell presented Health Care Access with a check for $100 in honor of Moran and Sloan and their support of safety net clinics.

The event just happened to be during Primary Care Safety Net Clinic Week in Kansas. It's a campaign to recognize that these clinics provided care for 223,000 people, regardless of their ability to pay.

Lawrence resident Bob Kania gets a visit from Rondi Erickson, his case manager who is employed by communityworksinc. They were discussing topics ranging from Medicaid to Johnny Cash. Due to the recent Medicaid cuts, Erickson's wages and benefits were cut. She also had to file an extensive report in January that justified why Kania needs more than 10 hours of care per day. So far, the state is paying for his care.

Bob Kania is happy to be in his own home.

Just like you and me, the 44-year-old Lawrence resident enjoys playing games, joking with friends, eating good food, and cheering on his favorite team.

But for him, a paraplegic, none of it would be possible without the assistance of a home health agency. Instead, he would be in a nursing home or what he describes as “hell.”

In 1985, at age 19, Kania suffered spinal cord and brain injuries during a motorcycle wreck in Leavenworth. He spent six months in a coma, and then 12 years in and out of nursing homes and a rehabilitation center.

“It was awful,” he said. “I was not a happy camper.”

Then, he met Janet Williams, founder of communityworks inc., a home health agency that is primarily funded by the state’s Medicaid program.

It changed his life.

•••

Chris Frost, left, folds laundry for Lawrence resident Bob Kania, a paraplegic. Frost is a personal assistant who was hired by Kania, but gets paid by Medicaid. The recent state budget cuts put Kania's home care in jeopardy. His case manager had to file an extensive report that justified his need for more than 10 hours of care per day. by Kevin Anderson

They met at a nurses station in a nursing home. Kania started to strike up a conversation with Williams, and the nurse said, “If he is bothering you, let me know.”

“It was like he wasn’t even there,” Williams said. “He was on his elbows on a gurney. He could not straighten his arms because he had been on that gurney so long.”

Williams said he shared a wheelchair with someone else, and whoever got up first got the wheelchair.

“It wasn’t up to Bob who got up first; it was up to the personal care attendant,” Williams said. “He was at the mercy of the people.

“The breakdowns on his behind got so bad he couldn’t sit in the wheelchair, so they would just put him on a gurney that he couldn’t propel himself.”

She asked him, “Do you want to get out of here?”

In 1997, the agency helped Kania move into an east Lawrence home and began assisting with hiring personal assistants paid for by Medicaid.

He has six attendants who do everything from cooking and cleaning to wound care and transfers.

“I depend on them with my life,” Kania said.

That life-saving care was put into jeopardy when Gov. Mark Parkinson cut the Medicaid reimbursement rate by 10 percent on Jan. 1.

Williams was forced to cut $800,000 from the agency’s already-tight budget.

Communityworks serves about 80 Lawrence residents, like Kania, with brain injuries and other disabilities. It serves 480 people in Northeast Kansas.

Williams said cutting such services doesn’t make financial sense.

For example, she said the agency saves the state $21,000 per month by providing rehabilitation services for those with brain injuries in the home instead of in a rehabilitation hospital. Last year, the agency saved the state $45 million.

“Our outcome data shows that people get better faster at home. That’s because they practice the therapy and skills in their homes,” Williams said.

The other goal is to help these people transition from the state’s Traumatic Brain Injury Waiver program to its Physical Disability Waiver program — like Kania did — with far fewer services.

While Kania may not be saving the state money now, his quality of life has greatly improved. Williams doesn’t want to see Kania revert to the person she met in the nursing home.

“The challenge is, you can’t cut people because everybody works one to one with consumers, so someone has to fill those shifts. That’s why we cut pay and not people.”

A majority of the agency’s 500 employees suffered wage and benefit cuts.

Kania’s case manager, Rondi Erickson, was among them.

She meets with him at least once every two weeks and checks in weekly by phone. She’s always on call to make sure his needs are being met. She also handles 19 other cases.

“I don’t mind taking a cut because I am here for the people. I never got into this type of work for the money,” Erickson said. “We get to help people as much as we can and see people succeed and have amazing lives.”

Because of the Medicaid cuts, she had to fill out an extensive report in early January to justify why Kania needs more than 10 hours of services per day; otherwise funding would be cut. Erickson said Kania needs 14 hours, and so far the funding is being provided.

But, Kania lost benefits for dental care such as oral examinations, X-rays and crowns. Now, Erickson said, “Medicaid pays for pulling teeth and that’s about it.”

If Kania’s equipment fails, it’s going to be more difficult to get it replaced because state funds have been frozen, except for emergency situations.

“If he needs parts for his wheelchair, if he needs a new lift or any equipment that helps keep him in his home, we will have to spend a lot of time justifying it,” Williams said. “And, we still may not get approval for it.”

It also may become harder for Kania to see a doctor because fewer are accepting Medicaid patients. That’s because doctors often don’t get reimbursed enough to cover the costs of providing care. There are about 25,000 Kansas health professionals registered to take Medicaid patients, according to the Kansas Health Policy Authority. But it’s difficult to tell how many providers actively participate in Medicaid. Health care providers who decide to stop accepting Medicaid patients are not required to notify KHPA that they have done so.

Lawrence resident Bob Kania, left, plays a Wii bowling game with Chris Frost, one of his six personal assistants who are paid by Medicaid. Frost does everything from cooking and cleaning to wound care and transfers. Kania said he depends on Frost with his life. That life-saving care was put into jeopardy when Gov. Mark Parkinson cut the Medicaid reimbursement rate by 10 percent on Jan. 1. Communityworksinc., the agency that assists Kania with his care, was forced to cut $800,000 from its budget. by Kevin Anderson

Williams hopes the state’s budget ax has fallen for good.

If not, she may have to cut the already low wages — about $8.50 per hour — of the personal assistants who care for Kania. It’s something she hasn’t done yet because she knows good help is hard to come by.

Erickson agrees.

“They get paid so little anyway and they do the dirty work. They have the hardest job. It may be one of the most rewarding jobs, too, but they have a hard job,” she said.

Chris Frost, 27, of Lawrence, has two jobs and one is taking care of Kania.

“It’s not about what you make here,” he said. “It’s about the companionship and the camaraderie. We want to see Bob at his best all of the time.

Frost has known Kania for about 10 years.

“Since he has lived here, it’s just gotten better and better,” Frost said. “Without this kind of funding, he wouldn’t be here. He wouldn’t be living independently and that would be unfortunate.”

In 2008, there were 11,048 Douglas County residents receiving Medicaid services or about 10 percent of the population.

Williams said everyone is one accident from needing such services.

“It can happen to anyone,” Williams said. “We are all one car wreck away from Medicaid.”