On April 4, KanCare celebrated its 90-day birthday, a critical milestone in the new Medicaid program. Critical, because it marked the deadline for beneficiaries to switch from their assigned managed care organization (MCO) to another, if they so choose. It’s also a symbolic milestone, essentially marking the day when KanCare is no longer in its infancy. So, what’s the prognosis at the 90-day check-up? The doctor’s still out on that one, but there is a lot of ongoing monitoring that needs to happen.
The adequacy of the provider network, especially for specialty providers and dental care, remain a concern for advocates. One reason for concern is that some providers are not selecting to sign up with all three MCOs. This is especially problematic in smaller or more rural communities where there may only be one hospital, pediatrician or dentist in the community. In one instance, a child’s physician and dentist only signed up with one MCO — but not the same one, so the parent was forced to choose between providers when selecting a plan. It is bumps in the road like this that need to be ironed out as KanCare moves forward.
Some providers have expressed concerns about timely payments and new requirements for pre-authorizations that weren’t required prior to KanCare. As concerns persist about the adequacy of the provider network, it will be especially critical that those providers who are participating have timely payments and the least amount of red tape possible. The good news is that the state is responding to concerns about this by implementing more frequent phone calls with providers to hear the concerns and address them as soon as possible. The other good news is that the Legislature is close to final approval of requiring legislative oversight of KanCare, which will allow for ongoing transparency of program outcomes and a venue for concerns to be raised from advocates and consumers in a public setting.
This post originally appeared on KAC’s blog., republished with minor modifications with permission.