It's arguably the biggest change in the history of the Medicaid program in Kansas. KanCare, the privatization of Medicaid, now has the go-ahead from federal officials, and will launch January 1 2013.
The announcement came from the federal Centers for Medicare and Medicaid Services, or CMS, Friday afternoon. Lieutenant-Governor Jeff Colyer, the Brownback administration’s point man on KanCare, participated in the announcement by speaker phone.
“In the last two hours, CMS and the State of Kansas have been reaching out to Kansas stakeholders to let them know about the CMS decision to allow KanCare to start January 1," he says.
"Today’s announcement resolves the uncertainty of KanCare for both consumers and providers.”
Nearly all Kansans currently covered by Medicaid are being assigned to one of three managed care organizations. Colyer says those contractors are being incentivized to produce savings by providing better, more integrated care.
“KanCare will not cut off thousands of Medicaid recipients, like Missouri and other states have done. KanCare doesn’t make double-digit rate cuts to providers, like California and other states," he says.
"The state expects to save more than $1 billion over the next few years through improved care and coordination, and better outcomes.”
Not all Kansans are as enthusiastic as the lieutenant governor about starting the new program three weeks from now. Anna Lambertson heads the Kansas Health Consumer Coalition. She says she wasn't surprised, but she was disappointed.
"It certainly would be our preference for implementation of KanCare to be delayed, maybe about six months,” says Lambertson.
She says her organization has spent the past year advocating for changes in the program to better protect Kansans who rely on it for their medical care.
“Under the original proposal, for example, folks would’ve only had 45 days to either stay in the plan they were auto-assigned to, or select one of the other two plans," says Lambertson.
"We said 45 days isn’t enough time for people to make that kind of decision for them and their families. And as a result of that advocacy from us and our partner coalition members, the state has had to maintain that 90-day time frame.”
Lambertson says her group’s advocacy efforts will continue, even after the official launch of KanCare.
“We’ll continue to push for an independent ombudsman program," she says. "We’ll continue to push for robust outreach and education from the state. We’ll continue to make sure that stakeholders are involved in the implementation of the program. And of course we’ll continue to promote transparency and accountability.”
That will include lobbying for the creation of a legislative oversight committee to monitor the KanCare program.
Children in low-income families covered by Medicaid are already in a form of managed care. For the last 10 years or so, the state has tried to market that program under the name HealthWave.
Shannon Cotsoradis heads the advocacy group Kansas Action for Children. She thinks it might reduce confusion if KanCare used the HealthWave name, too—at least for the first year.
“While folks in Topeka have spent a long time talking about this transition, I think children and families across the state are less aware that there’s a transition for HealthWave to KanCare coming," she says.
"So, I think my biggest concern is will families know that their healthcare provider is now KanCare?”
Those families should have received a letter by now informing them which insurance company they’ve been assigned to.
“You know, it’s important for families to know that they do have a choice," says Cosoradis.
"They can select a new managed care provider if they don’t like the selection that’s made for them. But more importantly, I think the question is, will families open the envelope that arrives in the mail, telling them who their new managed care organization is?”
Since each company has its own provider network, families may find that a different company would better meet their needs. If they let the 90-day selection period pass without making a change, they’ll be out of luck until the following year.
But even with federal approval of the January 1 start date, the complete details of KanCare are unclear. There are several terms and conditions that go along with that approval, and those still haven’t been spelled out.