Kansas officials seeking to renew KanCare are asking people covered by the privatized Medicaid program to trust them to make it better.
In a series of recent public hearings, state officials have assured providers and beneficiaries that KanCare 2.0 will fix the administrative and service-delivery problems that have plagued the current program since its inception.
Dynel Wood isn’t convinced. She runs a small Johnson County company that provides support services for Kansans with disabilities.
“We’ve heard before that things would be better,” Wood said after a recent public hearing in Olathe. “We’ve been promised things and it doesn’t happen. There is a trust issue.”
Since 2013, three for-profit companies known as managed care organizations, or MCOs, have administered KanCare, which provides health insurance to more than 420,000 low-income, disabled and elderly Kansans. Though many states have contracted with MCOs to run their Medicaid programs, Kansas was the first to privatize services for people with disabilities.
The move to privatization prompted immediate complaints from providers and recipients alike about increased red tape and reductions in services. Those complaints have subsided in recent years but haven’t stopped.
In particular, families of Kansans with developmental and physical disabilities continue to raise concerns about cuts in services.
“We have lots and lots of KanCare recipients or their guardians coming to us with concerns about services that they need but are not getting,” said Sen. Laura Kelly, of Topeka, the top Democrat on the Senate’s health and budget-writing committees.
Jon Hamdorf, the state’s interim Medicaid director, is among the officials promising that things will be better under KanCare 2.0.
“I think that trust is a living thing and you have to earn it every single day,” Hamdorf said.
But he acknowledges that there continues to be “some anxiety over a few aspects of the program that we still need to better clarify.”
‘It’s really bad’
Suzy Springer is anxious to settle a long-running dispute over her mother’s nursing home bill. Unable to get answers over the phone, she showed up at a public hearing last week in Topeka.
“I thought, well, since I just absolutely can’t make contact with anybody out there, surely somebody here could help me,” Springer said.
Before privatization, Springer said she could go to an office in Topeka and talk with a “real person.”
“Sometimes you would have to go home and get some more paperwork, but it would get resolved,” she said. “They knew what they were doing.”
Now, she said, “it’s like a big mystery.”
She asked one of the officials who helped lead last week’s meeting how to set up a face-to-face meeting, but he didn’t know the office address and had to draw her “a little map” on a table napkin.
“Not being able to go talk to somebody when you have a question or have a problem, it’s bad. It’s really bad,” Springer said.
Sonja Willms, of Topeka, also has concerns. Damage done to her internal organs by pregnancy complicated by diabetes forced her to undergo double transplant surgery in 2014. Now 46, she depends on both Medicaid and Medicare to help her pay for the costly drugs she needs to stay alive.
“Just one of my anti-rejection medications is $18,000 a month,” Willms said. “I’ll tell you, there are times during all of this in my life that I felt they probably would much rather have me pass away than keep me around and pay for my medical bills.”
She said proposals that in her view are aimed at restricting enrollment demonstrate a lack of empathy for needy Kansans.
“It sends a message,” she said. “It’s hard not to interpret it that way.”
Beyond the trust issue
A lack of trust isn’t the only obstacle that KanCare officials are facing.
They also must overcome growing opposition to some of the changes they’re proposing in KanCare 2.0, most notably a work requirement and a lifetime cap on services for some beneficiaries.
The new policies will help non-disabled KanCare enrollees become self-sufficient, Hamdorf said.
“It is a path to independence,” he said. “It’s getting people re-engaged. Giving them the skills they need to be successful and starting them on their trajectory of a good life.”
But some lawmakers and advocacy organizations argue the proposed changes are an attempt to purge low-income adults from the KanCare rolls.
“It’s punishment,” said Sheldon Weisgrau, a policy consultant to several regional health foundations. “It’s the idea that these people are lazy and choosing not to work, and that’s just not real.”
Weisgrau and others argue that work requirements are illegal under the 1965 law that created Medicaid and Medicare. Even so, at least eight states — Arizona, Arkansas, Indiana, Kentucky, Maine, New Hampshire, Utah and Wisconsin — are seeking to implement them. And Seema Verma, the new head of the Centers for Medicare and Medicaid Services, has signaled she will likely give them a green light.
Only about 12,000 KanCare recipients — most of them parents of children 6 and older — would be subject to the work requirement and 36-month coverage limit.
Rep. Brett Parker, an Overland Park Democrat, said several lawmakers are discussing how to stop the administration from proposing the work requirement and coverage cap.
“We can make sure that the Legislature has approval on changes,” Parker said. “I think we have a role to play in oversight here. We have that power and we need to exercise it.”
Timing and politics also issues
The Brownback administration wants to implement the new version of KanCare on Jan. 1, 2019, just days before a new governor takes office.
That timing is a concern for legislators on both sides of the aisle, said Republican Sen. Vicki Schmidt, chairwoman of the Senate Public Health and Welfare Committee.
“I believe there will be significant discussion about that,” Schmidt said.
Kelly, Schmidt’s Democratic colleague on the health committee, said, “I don’t think we want to tie the hands of an incoming administration literally through the entire first term and maybe into their second term.”
If KanCare 2.0 is implemented on schedule, it wouldn’t expire until Dec. 31, 2023.
If the new elected chief executive turns out to be current Lt. Gov. Jeff Colyer, he would have no objections. But many other gubernatorial hopefuls — both Republicans and Democrats — have been highly critical of KanCare.
“I think we ought to scrap KanCare 2.0,” said Republican Jim Barnett, a physician and former state senator who lost the 2006 governor’s race to Democrat Kathleen Sebelius.
“I don’t think they (the for-profit MCOs) have done a good job,” he said. “We should be creating our own nonprofit accountable care organization in Kansas.”
Another former legislator, Democrat Josh Svaty, said he heard numerous complaints about KanCare when he toured the state last summer to kick off his gubernatorial campaign.
“Kansans are not receiving the level of services that they were receiving prior to the implementation of KanCare,” Svaty said, indicating that he would consider ending privatization and going back to a state-run system if elected.
Jim McLean is managing director of KMUW's Kansas News Service, a collaboration of KMUW, Kansas Public Radio and KCUR covering health, education and politics in Kansas. Follow him on Twitter @jmcleanks.
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