KanCare

A federal judge has thrown out Centene Corp.’s abuse-of-process claim against a former employee who alleged she was fired after complaining about the managed care company’s business practices. 

Centene is the parent company of Sunflower State Health Plan Inc., one of three for-profit companies managing KanCare, Kansas’ privatized version of Medicaid.

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More than 389,000 Kansans and nearly 2 million Missourians were affected by last month’s massive cyberattack on Anthem Inc., the nation’s second largest health insurer, figures released by the company show.

“This data breach is so far-reaching that it impacts nearly one-third of our state’s population,” Missouri Department of Insurance Director John M. Huff said in a statement Monday.

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It’s likely that the records of some Kansas Medicaid recipients and Missouri Blue Cross and Blue Shield policyholders were compromised by a cyberattack on the Anthem health insurance company.

The breach was discovered last week but news of it wasn’t made public until Wednesday.

Kansas Gov. Sam Brownback’s administration outlined a sweeping budget plan Friday that includes changes to Medicaid and increases in the state’s tobacco and alcohol taxes.

Budget Director Shawn Sullivan said closing a $650 million budget gap will require new tax revenue and slowed expenses in the state’s “three major cost drivers”: public schools, public employee pensions and Medicaid.

“It is time to make additional changes to both better the care coordination of 400,000-plus members in Medicaid and, second, to further bend down the cost curve in Medicaid,” Sullivan said.

An incendiary lawsuit over the business practices of one of the companies running KanCare, the Brownback administration’s privatization of Kansas’ $3 billion Medicaid program, just got more explosive.

The company, Sunflower State Health Plan Inc., responded forcefully Monday to a lawsuit accusing it of unethical behavior, saying the plaintiff – an executive who was fired – was trying to extort it.

Republican members of a joint legislative committee say there’s no need to launch a state investigation into allegations that lobbyists connected to Gov. Sam Brownback engaged in “pay to play” deals involving KanCare, the state’s privatized Medicaid program.

Rep. Jim Ward, a Wichita Democrat and member of the KanCare Oversight Committee, on Tuesday urged members to recommend the formation of an investigative committee in a report they’re preparing for legislative leaders.

State officials will need to find an additional $40 million to meet rising KanCare costs in the current budget year, according to caseload estimates compiled by the nonpartisan Kansas Legislative Research Department.

KanCare is the name of the state’s privatized Medicaid program.

Also, an anticipated increase in the number of children in the foster care system will require an additional $10.2 million in state funding in the current budget year, which ends June 30.

KHI News Service

Dr. Robert Moser has resigned as secretary of the Kansas Department of Health and Environment.

His resignation will be effective at the end of the month.

Moser broke the news to the agency’s staff late Monday afternoon in an email.

“I am stepping down from my current position as KDHE secretary and state health officer effective the end of November,” Moser said.

Moser said “it was a hard decision” to leave the state’s public health and Medicaid agency.

“However, it is the right time for me and my family to look at other opportunities,” he said.

A lawsuit alleging that one of the for-profit companies running KanCare ordered employees to shift KanCare members away from high-cost providers has put a renewed spotlight on the program, one of the Brownback administration’s signature achievements.

In the lawsuit filed this week in federal court in Kansas City, Kan., a former official of the company, Sunflower State Health Plan Inc., claimed she was fired after she objected to the directive, saying it was unethical and possibly illegal.

Andy Marso / KHI News Service

 

About 6 percent of eligible adults took advantage of new dental coverage offered under KanCare in the first year of the managed care Medicaid program.

The switch to managed care Medicaid administered by three private companies extended basic dental cleanings to more than 130,000 adults ages 19 to 64.

According to Kansas Department of Health and Environment statistics, about 7,600 adults had a cleaning paid for by one of the managed care companies in 2013.

Dave Ranney / KHI News Service

 

 

Parents of adult children with developmental disabilities say state officials are breaking a pledge made during negotiations last year that led legislators to include Medicaid-funded home- and community-based services for the developmentally disabled in the state's KanCare program.

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Democratic gubernatorial candidate Paul Davis says if elected, he will reverse Gov. Sam Brownback’s controversial decision to put the private companies managing the state’s Medicaid program in charge of delivering support services to Kansans with developmental disabilities.

Brownback, a conservative Republican seeking a second term, privatized the state’s $3 billion Medicaid program in 2013 and renamed it KanCare to achieve two — and some say conflicting — goals of improving care and reducing costs.

A former state senator confirmed Thursday that he was contacted by FBI agents looking into allegations of “pay-to-play” deals in state government.

Dick Kelsey, a Republican who represented the Goddard area until 2012, said the FBI questions centered on David Kensinger, a longtime political adviser and former chief of staff for Gov. Sam Brownback.

“The FBI called me,” Kelsey said. “They wanted to talk to me and did a number of times, along with an in-person, two-hour interview. The investigation is very real.”

The top Democrats on the KanCare Oversight Committee on Monday called for a separate committee to be appointed to study whether any legal or ethical boundaries were crossed when Gov. Sam Brownback's administration contracted with three managed care organizations to privatize Medicaid.

Fifteen medical-related political action committees registered with the Kansas Governmental Ethics Commission had a total of almost $600,000 cash on hand at the July 24 reporting deadline, and officials from the top PACs said they're still forming the legislative agendas that may inform how they spend that money.

RELATED: Kansas Medical PACs Concentrate Spending On Incumbents

The three private insurance companies that administer the Kansas Medicaid program under KanCare lost $72.6 million in the first half of 2014, after losing $110 million in 2013.

Rep. Jim Ward, a member of a KanCare oversight committee who requested the fiscal information from the Kansas Department of Health and Environment, on Tuesday questioned how long the three companies can sustain such losses.

"These companies can’t keep subsidizing Medicaid to the tune of $100 or $150 million per year, and that’s what’s happening,” said Ward, a Wichita Democrat.

Kansas House Minority Leader Paul Davis, the Democratic candidate for governor, said Tuesday that if elected he would order a "top-to-bottom" review of KanCare.

Republican Gov. Sam Brownback spearheaded KanCare, which places the state's 400,000 Medicaid recipients under the administration of three private insurance companies, also known as managed care organizations (MCOs).

The governor has said the program is on track to meet its goal of saving the state $1 billion over five years through care coordination without cutting services, eligibility or provider payments.

The state’s privatization of Medicaid is complicating efforts to detect fraud and abuse, according to a recently released report from Kansas Attorney General Derek Schmidt’s office.

The 2014 annual report from the attorney general’s Medicaid Fraud and Abuse Division says the three private companies managing the state’s $3 billion Medicaid program — called KanCare — are not providing all the information needed for the state to conduct investigations.

Andy Marso / KHI News Service

The rural hospital that Dr. Roger Warren leads in Hanover, Kan., is owed about $140,000 by the three insurance companies the state contracted with to administer Medicaid. And as he walks the halls, Warren is able to point out exactly what that money means to his full-service medical clinic.

Whoever emerges as the top candidate from a crowded field of applicants for the state’s Medicaid inspector general post likely will be vetted more carefully than in the past.

Dr. Robert Moser, secretary of the Kansas Department of Health and Environment, said the Kansas Bureau of Investigation will conduct a background check of the candidate before he or she is appointed.

“It’s something that we’re going to require before extending the contract,” he said.

Bigstock

Kansas was one of just three states that saw their rates of people without health insurance go up since last year, according to a new survey.

And, if the poll results are accurate, Kansas was the one whose rates went up the most.

The data, collected as part of the Gallup-Healthways Well-Being Index, show that the uninsured population in Kansas rose from 12.5 percent in 2013 to 17.6 percent by midyear 2014 — a whopping increase of 5.1 percentage points.

State officials last week formally launched a “health home” initiative they hope will help Medicaid enrollees with mentally illnesses live healthier lives and lower the state’s health care costs. 

“We have several goals,” says Becky Ross, director of Medicaid initiatives at the Kansas Department of Health and Environment. “But the main goal, first and foremost, is to keep people out of the emergency room, reduce inpatient stays as much as possible and help people learn more about how to manage their chronic conditions, whatever those conditions might be.”

Council of Economic Advisors / Executive Office of the President of the United States

A study released earlier this month by the White House Council of Economic Advisers says the decision not to expand Medicaid is costing Kansas millions of dollars and thousands of jobs.

According to the study, Kansas is passing up $820 million over the next three years by choosing not to expand Medicaid eligibility. The federal government would pay for nearly all of the cost of the expansion, which would add as many as 100,000 Kansans to the state’s Medicaid rolls.

A Kansas state official insists there’s no backlog of Medicaid applications in the state, saying federal concerns have more to do with state and government computer systems not sharing information with each other.

Sara Belfry, a spokesperson for the Kansas Department of Health and Environment, said all of the state’s Medicaid applications are being processed within the 45-day period that’s allowed by the Centers for Medicare & Medicaid Services (CMS).

Kansas Medicaid providers with expansion plans ready to go after spending months and thousands of dollars preparing for the state’s new health homes initiative said they were “shocked” and “disappointed” that state officials abruptly chose to indefinitely delay much of the program’s implementation while giving the providers less than 24 hours' notice of the state’s decision to hit the pause button.

Where KanCare Meets Obamacare

Jul 1, 2014
Mike Shields / KHI News Service

Gov. Sam Brownback once called Obamacare “an abomination,” and with the federal health reform law now four years on the books bad-mouthing it has become a conservative Republican ritual.

But this week, after more than a year of planning and preparation by Kansas and federal officials, the Affordable Care Act and Brownback’s own KanCare initiative begin coming together in ways that will make the two programs indistinguishable to as many as 72,000 Kansas Medicaid beneficiaries.

Unlike its neighboring states of Missouri and Nebraska, where significant decreases have been reported, Kansas has seen a significant jump in the number of people enrolled in its Medicaid/CHIP programs, even without loosening its relatively tight eligibility standards.

According to a new report from the Kansas Department of Health and Environment, enrollment in the programs — together branded as KanCare — rose in April to a historic high of 426,642 people, or roughly one in seven Kansans. That’s up from 396,374 in April 2013.

The three private companies contracted to manage Medicaid services through KanCare lost money in the program's first year, according to a report released this week.

The total losses between the companies come to more than $100 million.

Rep. Jim Ward, a Wichita Democrat, is concerned that could lead to service reductions or the companies pulling out of the program altogether.

The FBI is investigating possible influence peddling by former aides of Kansas Gov. Sam Brownback, according to a story Sunday in The Topeka Capital-Journal.

The FBI is also looking into whether the governor’s office pressured the for-profit companies that run the state Medicaid system to use lobbyists from Parallel Strategies, a firm founded by the former aides, including the governor’s former chief of staff, David Kensinger, the newspaper reported.

Alex Smith / KCUR

The Affordable Care Act has put Sandy Praeger at odds with most of her fellow Republicans in Topeka, Kan.

The Kansas Commissioner of Insurance shared the frustration many had over the health exchange website problems, and she’s voiced concern over how shifting rules and delays impact the insurance industry.

But Praeger has remained a supporter of federal health reform, a proponent of Medicaid expansion, and a critic of Gov. Sam Brownback’s approach to health policy.

She answered five questions as part of our monthly series, KC Checkup:

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