Threats to Medicaid On Hold in Kansas – For Now

Amanda Gress is with Kansas Action for Children  

As the Kansas Legislature kicked of the 2018 session in January, threats to health care for Kansas children and families insured by Medicaid loomed large. Five months later, we are thankful that extremely harmful policy proposals are on hold – at least for the time being.

Last October, then-Governor Sam Brownback’s administration unveiled “KanCare 2.0”, the next version of the state’s Section 1115 Medicaid demonstration waiver. Kansas shifted to managed care in 2013, and the current KanCare program faces significant administrative challenges. The “KanCare 2.0” proposal included troubling provisions that would have ended health care coverage for some parents who are unable to meet work requirements. It also proposed creating a first-in-the-nation lifetime limit on Medicaid coverage for those parents.

The stakes are high for Kansas children and parents who depend on KanCare. Say Ahhh! Readers know that an entire family’s health and well-being suffers when a parent loses access to needed care. If Kansas parents lose coverage, their children are less likely to receive regular checkups and preventative care. When parents are not physically and mentally healthy themselves, they are not able to provide the best possible care for their children. And when one member of a family is uninsured, the entire family is financially vulnerable to unexpected medical emergencies. The harmful policy proposals in “KanCare 2.0” would have increased the likelihood that parents who were unable to meet new requirements or navigate administrative hurdles would lose coverage.

Stakeholders representing consumers, providers, and community organizations responded loud and clear: these proposals would jeopardize the health and well-being of children and their parents. We shared our opposition as the legislative KanCare Oversight Committee considered “KanCare 2.0” and as the state collected public comments on the new plan. Despite overwhelming opposition to these harmful proposals, in December the state submitted an application to CMS for “KanCare 2.0” – including the penalties for Kansas parents.

When the Legislature returned in January, legislative leaders voiced their opposition to “KanCare 2.0” and introduced bills to require legislative approval to make significant changes. This is a sensible policy. Since the stakes are so high for Kansans insured by KanCare, major changes to the program merit serious scrutiny and responsiveness to stakeholder feedback. The Legislature ultimately added language to the omnibus budget prohibiting the state from moving forward with a waiver application or managed-care contracts that substantially differ from the current KanCare program, including the addition of any new eligibility requirements, without express legislative approval (you can read the complete proviso here). Lawmakers also inserted a provision defunding the state’s entire Medicaid program if the state made changes to KanCare without legislative approval to the Medicaid line item in the budget.

We received surprising news in April. In response to legislators’ questions during a KanCare Oversight Committee meeting, the state Medicaid director shared that Governor Colyer’s administration was no longer pursuing a lifetime limit for some parents’ KanCare coverage. On May 7, CMS Administrator Verma notified Kansas that CMS would not approve the proposed lifetime limit. This was one of the most troubling aspects of the “KanCare 2.0” proposal, and its rejection is an important victory for Kansas children and families.

Last week, we received a second important piece of good news. Governor Jeff Colyer signed the budget May 4, including the prohibition on substantially changing KanCare without legislative approval (although he did line-item veto the proviso defunding the entire KanCare program if the state violated that requirement). That means that between now and June 30, 2019, the Kansas Legislature must approve any harmful new eligibility requirements before they can jeopardize Kansas children’s health and well-being. We still have work to do – the budget does allow the state to continue its negotiations with CMS regarding policy proposals to take away Kansas parents’ KanCare coverage if they’re unable to meet work requirements, and Kansas policymakers have not yet chosen to expand KanCare to cover more Kansas parents. However, it is a relief that Kansans’ hard work to expose the harm these proposals would cause has at least temporarily paid off by putting these policies on hold.