Health Forward Foundation

Problems Continue in Kansas Medicaid Overhaul

Jamea Richardson

OLATHE — Administrative headaches and treatment disagreements continue to dog Kansas’s overhaul of its Medicaid program, service providers said Wednesday at a meeting focused on the needs of people with developmental disabilities.

“There are dozens of state workers knocking themselves out to make this work — no question,” said Tom Laing, executive director of Interhab, an association that represents most of the state’s 27 Community Development Disability Organizations (CDDO). “But it’s a huge change, and it’s hard on the state to get it done right.”

Launched earlier this year by the administration of Gov. Sam Brownback, the revamped Medicaid program goes by the name KanCare.

The initiative shifted virtually all of the state’s 380,000 Medicaid enrollees into managed care plans run by the three for-profit insurance companies, known as managed care organizations (MCOs).

Brownback officials estimate the new program will reduce the growth in federal and state Medicaid spending in Kansas by $1 billion over five years.

At a news conference in Topeka on Wednesday, Brownback credited a KanCare “dividend” for allowing the state to reduce the list of persons with developmental disabilities who are awaiting home- and community-based services.

Lakemary Center, which serves clients in Miami and Johnson counties, organized the evening meeting here in Olathe. It drew about 45 people, including parents, service providers and case managers, to Lakemary’s day services facility in Johnson County. Lakemary’s main facility is in Paola in neighboring Miami County.

Some of the issues highlighted at the meeting were:

  • Dynel Wood, co-owner of an Olathe business that provides a range of developmental disability services, said it took a phone call and several emails for her to obtain a form from one MCO so a client’s guardian could give the OK for the company to talk about the client with Wood. “It just went on and on and on to get a blank form,” Wood said.
  • Lakemary Chief Executive Bill Craig said the average length of stay for clients in its Paola facility serving youth with psychiatric problems is now about three months, or about half of what it was before KanCare. “It’s not because these kids need less,” he said. “It’s because they are getting less.”
  • Jamea Richardson, a registered nurse and Lakemary’s coordinator of adult health services, told of a two-week battle with an MCO to convince officials that it was a bad idea to up the dosage of a psychiatric drug to a patient because it would save money by reducing from three to one the number of pills the patient would need to take each day.

Bridget Murphy, who is with the Down Syndrome Guild of Greater Kansas City, suggested that the audience members start keeping logs of the time they spend on hold or on other frustrating tasks with the MCOs. Then, she said, they could issue scorecards rating each company.

Angela de Rocha, a spokesperson for the Brownback administration on matters relating to the developmentally disabled, was not immediately available for comment.

In the past, however, state officials have said they are working hard to resolve issues that surfaced in the first months of KanCare.

They have also said they are meeting with all parties involved to avoid any problems with the planned Jan. 1, 2014 expansion of KanCare to include long-term services for the developmentally disabled. Advocates for the disabled fought the expansion for two years and continue to express strong reservations about it.

Ever since the administration announced the Medicaid overhaul, the advocates have argued that managed care is an inappropriate way to provide the non-medical support services that help the developmentally disabled live outside institutions.

Those services are of three general categories:

  • Day Services: Include help with employment or or activities such as volunteering or going to a day center.
  • Residential Services: Clients can receive assistance living independently in an apartment or group setting
  • Case management: Help coordinating all the client’s needs, including medical care and obtaining government benefits

The Kansas Department for Aging and Disability Services (KDADS) has scheduled four meetings around the state for the week of Sept. 23 to brief consumers and providers about including long-term developmental disability supports in KanCare.

At present, the CDDOs coordinate those services. State officials have said they intend to keep that system intact with KanCare.

KDADS is running a pilot to test how billing and services can work with full inclusion of the developmentally disabled.

According to the department, the pilot includes more than 550 consumers and about 25 providers.

Advocates for the disabled have criticized the pilot as being merely a transition to full inclusion as opposed to a full-fledged test of whether KanCare can provide good non-medical care.

The state has submitted a proposal to the federal government to wrap in the additional services for developmentally disabled clients. Advocates for the disabled have said they expect the Centers for Medicare and Medicaid Services will approve the plan, despite misgivings expressed to the agency.

State officials held public hearings on the plan in mid-July. At those hearings, parents expressed support for the current system and argued that the change would be needlessly disruptive.

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