The Topeka Capital-Journal
March 5, 2012
By Andy Marso
A four-person panel of health care policy experts told providers and advocates Monday it might be time to take their concerns about Gov. Sam Brownback’s managed care Medicaid plan to the Legislature or the federal government.
Several in the audience at the Topeka and Shawnee County Public Library said that although the administration has listened to their fears, it has done little to change the KanCare plan or slow its implementation.
“If you’re in session, use the time know to say your concerns and you can repeat your concerns,” said panel member Jodi Mitchell, executive director of the Kentucky Voices for Health, who spoke about problems in her own state’s transition to managed care. “When you have providers not getting paid, when you have businesses going out of business in rural areas where access is critical, legislators are going to listen to that.”
Mitchell suggested providers band together with representatives of Medicaid recipients who offered a familiar laundry list of anxieties cropped up during Monday’s forum, sponsored by the Kansas Health Consumer Coalition.
Providers and patient advocates criticized the speed and scope of the transition to managed care and the nearly unprecedented inclusion of long-term services for the developmentally disabled.
There were no state government officials on the panel. Coalition spokeswoman Anna Lambertson said Department on Aging Secretary Shawn Sullivan was invited to the afternoon panel discussion but had a scheduling conflict.
Sara Arif, spokeswoman for the Department on Aging, said the department first heard about the forum through the media, and Sullivan wasn’t invited to speak during a morning session when other panelists gave presentations.
Arif released a frequently-asked-questions page that said it was important for all Medicaid services to be included in the managed care plan to coordinate patient services in the most effective manner.
“Services for all Kansans served by Medicaid will be incorporated into the KanCare system so that the benefits of care coordination will be available to them,” the page reads.
There are five managed care organizations bidding on three state Medicaid contracts, with Kansas slated to switch over all services to managed care in 2013.
Administration officials have said it will save $850 million over five years without cutting provider rates or patient services.
Marvin Fairbank, a representative of Stormont-Vail Regional Health Center, asked Monday how that is possible.
“The way you do it is by improving coordination of care, and management of care so people don’t use high-end services on a regular basis,” said Scott Brunner, of the nonprofit Kansas Health Institute, in explaining the administration’s task for the managed care companies that are bidding on three state Medicaid contracts.
Brunner said the example often given by members of the Brownback administration is preventing hospitalizations by helping patients better manage their diabetes.
Using a now well-worn metaphor about a train leaving a station, some legislators have said they have few options for influencing the managed care plan beyond de-funding Medicaid.
Brunner, who directed the state’s Medicaid program from 2004 to 2006 at the Kansas Health Policy Authority, said there is other things they can do besides that “nuclear option,” including passing laws that restrict how agencies administer Medicaid or establishing legislative
oversight of the managed care companies that win the contracts.
The panelists also fielded several questions about the likelihood of the state receiving a waiver from the federal Center for Medicaid and Medicare Services. The center, which falls under the Department of Health and Human Services led by former Kansas Gov. Kathleen Sebelius, must approve the managed care plan for the state to continue receiving federal health care funds.
Joan Alker, an official from the Georgetown University Health Policy Institute, said the Kansas managed care plan is “a much bigger change” than she has seen proposed in other states and concerned Kansans shouldn’t hesitate to contact federal agencies that also have a stake in Medicaid.
“Obviously the secretary (of Health and Human Services) has a lot of interest in your state,” she said.
Arif said the waiver application process is ongoing.
“We have been talking with CMS, working with them on the wavier approval,” she said. “That’s going forward as it needs to. People are always welcome to email us, and if they feel they’re not being heard, they’re always welcome to contact CMS.”
Keith Tatum, of the Kansas Council on Developmental Disabilities, said Monday’s forum helped crystallize some of the next steps concerned groups like his can take.
“I thought it was very interesting that one of the things in the toolbox we learned today is CMS has some oversight, especially in the central office,” Tatum said. “People who are going to be affected by the KanCare implementation, those are folks who need to be letting lawmakers know at the state and federal level so there’s some checks and balances.”