Kansas privatized its Medicaid program in 2013, and there have been questions ever since--questions about how well KanCare is working. As Heartland Health Monitor’s Jim McLean reports, a new study may provide some answers.
On a snowy night in January 2012, Kansas lawmakers gathered to hear Gov. Sam Brownback deliver his second State of the State address.
One of the things he proposed was a total makeover of the state’s Medicaid program.
“We are transitioning from a Medicaid system lurching between cutting providers, patients or both to one that gets better results for our most vulnerable Kansans," Brownback said.
Brownback launched KanCare a year later. It gave three managed care companies, or MCOs, responsibility for providing health care to approximately 400,000 low-income, disabled and elderly Kansans.
There were complaints from the beginning.
Consumers like the late Finn Bullers complained about losing services. Bullers had muscular dystrophy. And he told lawmakers that he wouldn’t be able to stay in his Prairie Village home if his hours of care were reduced.
“My care will go from 168 hours a week to 40 hours a week," he said. "That’s a 76 percent decrease in care.”
Providers complained too. They said the MCOs weren’t paying them on time. In some cases, not paying them at all, said Linda Sherman, who work in the business office at Lawrence Memorial Hospital.
“There is a pattern to just deny those claims and see if the provider will spend the time and the energy and the money to pursue them through the appeals process," she said.
When pressed for answers, the heads of the managed care organizations repeatedly assured lawmakers that the problems were being addressed.
“We’ve given you some detail year-to-date on where we are paying many of our providers," Laura Hopkins, CEO of Amerigoup, testified in August 2014. "And I will say that related to hospital payments we’ve made a lot of really good progress.”
But with the state about to seek federal approval to continue KanCare, providers wanted a more objective view. So they contracted with a consulting firm headed by former Health and Human Services Secretary Mike Leavitt, a one-time governor of Utah, to do an assessment of KanCare.
“We felt like something needed to be to actually assess the situation," says Tom Bell, president of the Kansas Hospital Association.
Robin Arnold-Williams directed the assessment. She says KanCare has slowed Medicaid cost growth by hundreds of millions of dollars – just as Brownback said it would. But some of the savings, she says, were achieved at the expense of providers and patients.
“There is a concern among providers that some of the, quote, 'savings' are the result of cost shifting," she says.
Going from a single state Medicaid agency to three managed care companies dramatically increased the administrative burden on providers.
“We heard very strongly from providers that the need to do things three different ways has greatly increased their costs," Arnold-Williams says. "They’re not reimbursed for those costs.”
Bell says the state’s budget problems are making matters worse. In July, Brownback ordered an across-the-board cut in provider reimbursement rates to cover red ink in the state budget.
State officials who oversee KanCare are taking issue with the Leavitt report. They say it underreports the health improvements that have been made.
But legislators say it raises several important questions, not the least of which is whether the state has done enough to hold the managed care companies accountable.
Sen. Laura Kelly, from Topeka, is the top Democrat on the KanCare oversight committee.
“We have given too much control of the program to the MCOs," she sayd. "There are so many things within the initial contract that we don’t monitor. We don’t know if they’re happening.”
And so, the questions continue--not only about KanCare, but about whether the state will still need the federal government’s permission to continue it.
Many expect President-elect Donald Trump and Republican majorities in Congress to overhaul federal Medicaid policy when they repeal and replace Obamacare.
