A public letter by the head of the Kansas Department for Aging and Disability Services praising KanCare’s effect on Kansans with disabilities has drawn a string of rebuttals from people who provide disability services.
Tim Keck’s letter was published Oct. 24 on the Wichita Eagle editorial page.
In it, the interim KDADS secretary said KanCare — the state’s move to privatize Medicaid under the administration of three insurance companies — has improved the lives of Kansans with disabilities and that the state’s safety net is strong.
Kansans with disabilities are receiving 36 percent more home and community-based services and making 29 percent fewer trips to the emergency room since KanCare began, according to Keck.
“The health concerns of the disabled are being addressed earlier and more effectively than they had been under the old system,” he said in his letter.
Keck’s letter was itself a rebuttal to an editorial by Gary Blumenthal that the Eagle published a week earlier.
Blumenthal, a former Kansas House representative and current member of the National Council on Disability, had urged the federal Centers for Medicare and Medicaid Services to reject efforts by Gov. Sam Brownback’s administration to renew KanCare past 2018.
Blumenthal said KanCare has caused hardships for disability providers since its launch in 2013.
After Keck’s letter was published, those disability support providers began speaking up themselves. Editorials from providers rebutting Keck’s characterization of the strength of the safety net appeared in the Eagle and the McPherson Sentinel. Interhab, a Topeka-based advocacy group for providers, released a letter written by Executive Director Tim Wood.
Download the letter by Interhab Executive Director Tim Wood
Shrinking networks
The common refrain in their letters: KanCare had increased the bureaucracy for getting reimbursed while providing no better care coordination than the previous state-run Medicaid system.
Extra billing hassles, plus stagnant reimbursements and policy changes that resulted in budget cuts, are driving providers away from the industry and reducing care options for Kansans with disabilities, they said.
“The original intent of KanCare was to improve employment opportunities for people with disabilities, improve efficiencies and health outcomes, break down silos between systems, and improve behavioral health, to name a few,” Tim Cunningham, the executive director of Tri-Valley Developmental Services in Chanute, said in his Eagle editorial. “Yet none of these have come to fruition, and it can be argued that we have headed in the opposite direction.”
Doug Wisby, CEO of Multi Community Diversified Services, which serves people with disabilities in McPherson County and surrounding areas, said in his McPherson Sentinel editorial that Keck’s letter left him “incredulous.”
“A number of service providers across the state will no longer accept new individuals for services and some have gone out of business,” his editorial said. “This will continue to get worse.”
Officials who lead Johnson County’s government agencies that support residents with disabilities and mental illnesses penned their own response to Keck’s letter, which was backed up by the Board of County Commissioners.
In it they said their network already was shrinking with last month’s closure of Cornerstone Supports in Olathe and Johnson County Developmental Supports had asked the commissioners to hire extra staff to help Cornerstone clients who have intellectual and developmental disabilities as they look for new providers.
Download the Johnson County response to Tim Keck's letter
Federal oversight
Correspondence between state and federal officials obtained under the Kansas Open Records Act shows that CMS regulators had questions about the strength of KanCare’s disability supports networks before Cornerstone closed.
Richard Overcast, a health insurance specialist with the CMS regional office in Kansas City, sent an email to state officials Aug. 11 with a series of five requests for more information on KanCare network maps sent to him about a week earlier.
“Please provide evidence showing, or describe the basis of your conclusion, that the provider networks illustrated in the data are sufficient to serve the enrollees in the service area,” Overcast wrote in his final request.
Mike Randol, director of the Division of Health Care Finance at the Kansas Department of Health and Environment, responded by sending data from the three KanCare managed care organizations, or MCOs, and saying the state would vouch for them.
“The state certifies the documentation submitted by the MCOs complies with the state’s requirements for availability of services,” Randol wrote.
Download the letter to CMS by Mike Randol of KDHE
Wood, in his letter on behalf of Interhab last month, said CMS officials continue to scrutinize the networks and were in Kansas doing a comprehensive review of KanCare when Keck’s editorial was published.
“The result of (the review) will most certainly show that KanCare is not a ‘remarkable success’ for Kansans with disabilities,” Wood said.
But not all providers have a negative impression of KanCare.
Ben Swinnen, executive director of Equi-Venture Farms in Topeka, said adapting to three MCO billing systems involved some challenges, but on the whole KanCare has been positive for him.
“I’m trying to engage (with the MCOs) rather than say, ‘Why is it not happening?’ and through that engagement I’ve had fabulous results,” he said.
Swinnen said his company has remained open for referrals of new clients with developmental disabilities since KanCare began and has added the capacity to serve about 15 percent more people in each of the last three years.
He now serves more than 100 clients and recently expanded his enterprise by buying a small agency in Newton that was struggling.
“It’s not perfect,” Swinnen said of KanCare. “But it is not a story of failures. It’s a story of attempts that have been positive.”
Andy Marso is a reporter for KHI News Service in Topeka, a partner in the Heartland Health Monitor team. You can reach him on Twitter @andymarso
