Brownback’s KanCare plan could put disabled at risk, says agency director


The leader of a local agency representing the needs of residents with developmental disabilities is asking Marion County residents to contact their senators and representatives about Gov. Sam Brownback’s KanCare plan.

Elizabeth Schmidt, executive director of Harvey-Marion County Community Develop­mental Disability Organization, said Brownback’s plan, if implemented, could have disastrous consequences for their clients.

“This is the first time that Kansas has looked at turning all Medicaid services over to for-profit, out-of-state managed care companies,” Schmidt said. “Urge your senators and representatives to sign on to the House and Senate resolutions that urges Gov. Brownback to slow down on KanCare.”

“If we don’t, three for-profit, out-of-state insurance companies that win bids for KanCare will have barely six months to set up managed-care systems for tens of thousands of vulnerable Kansans,” Schmidt said.

An overview

Schmidt said “managed care” is like a health maintenance organization, where the individual has to use a provider within the network and have medical services approved prior to receiving them.

If Brownback’s plan goes through, contracts will be awarded to the three for-profit companies by summer.

“By November, all individuals who receive medical cards will be assigned to one of the three managed-care organizations,” Schmidt said.

All other health-related entities that bill Medicaid for reimbursement also will have to contract their billing systems through the three managed-care organizations.

Schmidt said that would include doctors, hospitals, pharmacies, nursing facilities, home health agencies, hospice agencies and mental health centers.

“No other state has tried to put all Medicaid services into managed care in this short of a time frame,” she said.

“My fear is the risk of harm to vulnerable adults and small providers in small communities. Let’s tell our own story here in Kansas—take our time and do what is right for Kansans and Kansas business.”

Kentucky’s program

Schmidt said Kentucky implemented a managed-care plan with three companies starting Nov. 1, 2011.

“It has been disastrous, both for people with Medicaid and for small companies and providers,” she said.

An article from The Frank­fort Courier-Journal quoted the chief medical officer at a regional community health service as saying: “Patients are being denied medication, forced to try cheaper medications they’ve already used unsuccessfully, or not getting them in time because of delays in approval from managed-care companies.

The CMO said Kentucky’s plan is “dangerous, and it ultimately is going to cost us a lot of lives.”

Brownback’s plan goes even further than Kentucky’s, according to the Kansas Health Institute. It has called Brown­back’s plan to remake the state’s system for delivering health care to the poor, elderly and disabled “among the most far-reaching in the United States.”

KHI reported that former Kansas Gov. Kathleen Sebelius, now secretary of the U.S. Department of Health and Human Services, will have broad latitude to approve or deny the state’s Section 1115 waiver request, which will be submitted as part of the KanCare plan.

Section 1115 waivers provide a mechanism for states to use federal funds in ways that do not conform to federal standards.

“I don’t think people understand the magnitude of what this is,” Bob Day, a retired policy consultant in Maryland who served as Kansas Medicaid director under former governors Bill Graves and Sebelius, was quoted as saying.

“It’s a big deal to get Medicaid to approve it,” he added. “Whether they can do it in the time frame they’re talking about seems not realistic to me.”

According to KHI, nothing in federal law or regulations would require Sebelius to approve or even consider the state’s waiver request in the timeframe that Brownback officials are banking upon.

Past waiver approvals of this type—though generally less ambitious—under current and previous federal administrations usually haven’t happened in six months or less.

Delays in payments

Schmidt said articles have warned that the plan has resulted in delayed payments, late payments by managed-care companies and the harm to small companies.

The continued ripple effect has independent pharmacies in small towns and rural areas going out of business because reimbursement is less than the actual cost and is not being paid on time.

Local resolution

Schmidt appeared before the Marion County Board of Commissioners March 5 to introduce a resolution about the issue. It was signed by all three commissioners.

Schmidt told commissioners the proposal would have a far-ranging impact on health care in the county, ranging from routine medical to pharmacy and hospital care, plus home health, mental health and long-term care, including persons with intellectual and developmental disabilities.

Currently, Kansas contracts with 27 CDDOs, appointed by county commissions, who in turn contract with private companies who provide services, she said.

“We already have an effective, efficient, privatized system that is not overspending,” Schmidt said.

In fact, the administration’s proposal overlays the present efficient, effective system with a layer of administrative bureaucracy.

In fact, a study conducted by the University of Minnesota’s College of Educa­tion and Human Development found that Kansas’s costs for long-term care for people with developmental disabilities has actually decreased.

Over the past two decades, the average cost of long-term care per person in Kansas has gone from an average of $49,418 per person per year in 1993 to $41,936 per person per year in 2009, according to Schmidt.


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