KanCare is in trouble. The state of Kansas’ Medicaid program, which has been run by three Managed Care Organizations (MCOs) since being privatized in 2013, is beset by administrative and operational problems that threaten the health and safety of its beneficiaries, among the most vulnerable Kansans.
Patients, advocates, health care providers, and others engaged with KanCare have been sounding the alarm for years. But it took a series of letters from federal officials detailing the results of in-depth program audits to make much of the public, the media, and Kansas legislators stand up and take notice.
The federal audits, conducted by the Centers for Medicare and Medicaid Services (CMS), detailed a series of pervasive problems, including: failure to properly oversee the MCOs; inadequate coordination and collaboration between state agencies responsible for the program; lack of engagement and adversarial communications with stakeholders and non-responsiveness to their concerns; failure to engage patients in developing plans of care; inadequate verification of the adequacy of provider networks; absence of a comprehensive system for reporting, tracking, and trending critical incidents; etc.
The findings went on for 13 pages.
The conclusions “Results of our on-site review confirm that Kansas is substantively out of compliance with Federal statutes and regulations, as well as its Medicaid State Plan. Kansas has failed to administer the KanCare program as required…” and “This noncompliance…places the health, welfare, and safety of KanCare beneficiaries at risk and requires immediate action.”
This bombshell was withheld from legislators and the public by state officials until it was exposed by the news media through open records and freedom of information requests. Reporters subsequently uncovered an even earlier CMS letter, also not revealed to legislators and the public, that detailed serious deficiencies with home and community-based services provided to Kansans with disabilities.
Again, federal officials determined that the state fell short of performance metrics and was out of compliance with federal law. And again, these findings came as no surprise to patients and advocates who had been bringing them to the attention of KanCare officials and state legislators for years.
All this comes on top of the ongoing failure of the state to enroll applicants to KanCare in a timely manner. Despite repeated assurances from program officials over the course of more than a year, the state has continually missed self-imposed deadlines to clear an enrollment backlog numbering in the thousands. In the meantime, Kansans do not receive the care they need, or providers deliver care and never get paid.
Amid denials that the problems really exist and accusations that the audits were politically motivated “parting shots” from the Obama administration, the state has submitted plans of correction to the federal government.
But plans are not enough. What beneficiaries and Kansas taxpayers really need are the things that have been lacking since the beginning of KanCare.
First and foremost, a real commitment to judiciously administer the program, reflected in adequate funding, staffing, and oversight. A welcoming of the sunshine and transparency that is necessary in all government programs to ensure that taxpayers’ funds are being spent wisely and appropriate services are provided to the most vulnerable among us. And finally, an assurance that KanCare beneficiaries and their representatives will be included in all discussions about improving the program.
Kansans deserve better.
Follow me on Twitter @ACAResource and read my blog at http://healthpolicyrx.blogspot.com/