October 9, 2013
By Jim McLean
WASHINGTON, D.C. — Kansas legislators charged with overseeing the state’s KanCare program may find a new Florida study helpful.
The study, done by researchers at Georgetown University, suggests that individuals and organizations with a stake in that state’s Medicaid program closely monitor the transition to managed care.
“There are reasons to be concerned as commercial risk-based insurers expand their reach into vulnerable populations in Florida’s Medicaid program,” write researchers Joan Alker and Jack Hoadley. “Because these populations have higher health care needs, they tend to be more expensive and thus are sometimes targets for cost-cutting.”
The report is the most recent in a series of studies on a Medicaid managed-care pilot program that started in two Florida counties in 2006 and was expanded to include three more the following year. Next year, the state will transition its entire Medicaid population into managed care.
Kansas has already done that. Launched in January, Gov. Sam Brownback’s KanCare programtransferred nearly all of the approximately 390,000 Kansans enrolled in Medicaid into managed-care plans operated by three private companies.
Since then, Brownback administration officials have said that despite some “bumps in the road” the transition has gone relatively smoothly.
But earlier this week, representatives of several provider organizations told a legislative oversight committee that significant problems remain with KanCare, most of them related to delayed or disputed claims for payment.
“Claims are being overpaid, underpaid and in some cases not being paid at all,” said Tom Bell, chief executive of the Kansas Hospital Association in testimony to the first meeting of the Joint Committee on Home and Community Based services and KanCare Oversight.
Also at that meeting, a Prairie Village man with Muscular Dystrophy — Finn Bullers — publicly challenged a decision by the managed care company responsible for his care to reduce the number of hours of in-home care that he receives from 168 per week to 40.
Over-utilization?
Shawn Sullivan, secretary of the Department for Aging and Disability Services, said the old Medicaid system encouraged over-utilization in part because it allowed certain organizations to determine eligibility, draft plans of care and provide services. He said that he and other members of his staff had carefully reviewed Bullers’ case and agreed with the MCO’s assessment of his needs.
“We are comfortable with that reduction and the decision that the managed-care company made,” Sullivan said.
Even so, Bullers gave voice to what many Kansas with disabilities fear: that the MCOs will reduce services in order to meet the cost-savings requirements written into their contracts with the state.
State officials have estimated that the change to managed care will slow the projected growth in Medicaid costs by $1 billion over five years.
Gov. Brownback and others in his administration have said repeatedly that better coordination of the care provided to the most costly KanCare enrollees can both save money and improve outcomes.
“We’re going to coordinate the care better so that you get rid of the unnecessary things that happen in the system,” said Lt. Gov. Jeff Colyer, the administration’s point person on the KanCare initiative, when interviewed recently by Kansas City public television station KCPT.
However, the Florida researchers said that numerous studies have failed to show that Medicaid managed care programs either save money or improve health outcomes.
In the conclusion of their most recent report, they wrote:
“Although managed care carries the potential to coordinate the many care needs experienced by vulnerable populations and thus improve that care, the need for commercial managed-care plans to control costs and generate profits for shareholders may come into conflict with the cost of providing high-quality care.”