Public comment on KanCare plan expected to begin this week

Kansas Health Institute

May 9, 2012

By Dave Ramney

KANSAS CITY, Mo. — Officials with the federal Centers for Medicare and Medicaid Services say they expect to post Kansas’ new Medicaid waiver application on its website later this week. That will launch a 30-day public comment period on the proposal submitted by the administration of Gov. Sam Brownback.

The Brownback plan, called KanCare, would move virtually all the state’s 380,000 Medicaid beneficiaries into managed care plans run by private insurance companies beginning Jan. 1.

The so-called section 1115 Medicaid waiver is needed to implement the plan that state officials say will save the federal and state governments more than $850 million over five years while improving health outcomes for Medicaid patients.

“We anticipate that the KanCare section 1115 application will post on www.medicaid.gov this week, thereby initiating the 30-day federal public comment period, so long as it will not delay the processing of the application,” Julie Brookhart, of the CMS regional office in Kansas City, wrote in an email to KHI News Service. “CMS will review and consider comments received through the website, and reserves the right to request the state to address significant issues that arise from the public comments.”

Brownback officials submitted the waiver application April 26, one day before new CMS regulations on public hearings and transparency requirements regarding 1115 applications were due to take effect.

The Medicaid.gov website includes an 1115 Waivers page that lists state waiver applications and their status: current, expired or pending.

The pending waivers include a “Submit Public Comment” link, which takes the user to a “CMS Idea Factory” page that includes a box for submitting comments.

Comments are limited to 5,000 characters.

Those submitting comments will be asked to enter an email address. The addresses will not be made public.

The process will allow users to endorse others’ comments in a manner similar to social media websites. Each user will be allowed 10 “concurrencies” or votes, which may be cast in support of one to 10 comments.

“I find this very interesting – people are actually going to get to vote on a comment that they like,” said Joan Alker, co-director of the Georgetown Center for Children and Families and a research associate professor at the Georgetown University Health Policy Institute.

“I think CMS, absolutely, will review the comments that they receive,” Alker said. “It’s important for the public and for advocates to identify their top-tier issues and do some public education around them because the new voting system will allow CMS to see where there’s a real preponderance of interest and concern.”

Alker addressed a Kansas Health Consumer Coalition forum on KanCare earlier this year.

“We’re already planning our comments,” said Anna Lambertson, executive director of the coalition. “We’re not waiting. We’re going to be ready.”

The coalition’s comments, she said, likely would focus on the uncertainties surrounding KanCare’s implementation.

“The (KanCare) RFP (request for proposal) that’s out there says, ‘Here’s what we want to have happen, and we want the managed care companies to make it work,’” Lambertson said. “And then at the same time, we hear the administration saying it’s expecting KanCare to achieve $850 million in cost savings in five years. But there’s a lack of detail on how that’s going to happen.

“Our point is going to be that consumers don’t have enough information,” she said. “And we don’t think CMS does either.”

Kansas is one of five states that filed 1115 waivers within days of the April 27 change in CMS regulations. The others were Nevada, New Mexico, Ohio and Florida.

“The biggest difference between waiver applications that came in before April 27 and those that will come after April 27 is the public comment period,” said Dee Mahan, director of Medicaid advocacy with Families USA. “For Kansas, essentially, the public comment period is going to be limited to 30 days, so the advocacy community needs to be ready to weigh in. But I have to say that everything we’re hearing out of CMS indicates they’re planning on these reviews being very robust and very transparent.”

For applications filed after April 27, states will be required to have their own public comment period prior to filing and the beginning of the federal comment period.

Brownback officials have said they believe they met the intentions of the new requirement through a series of public forums last summer as they were gathering input for the plan they outlined to the public last November. They also point to subsequent meetings with various interest groups across the state and multiple legislative hearings on the KanCare plan.