Kansas Health
1:24 pm
Wed August 8, 2012

KanCare: Ready Or Not?

Less than five months from now, the Kansas Medicaid program is scheduled to convert to a privatized system.

In January, three for-profit, managed-care organizations will take over the federal/state program that pays for health care for low-income children, seniors and people with disabilities.  The new Medicaid system is called KanCare. State officials have been conducting meetings across the state to help people prepare for the change.

The informational meetings about KanCare took place in eight communities, including Salina, where Sharon Stepanek was in the audience.  Stepanek handles billing and insurance for an optometry practice in the northcentral Kansas town of Minneapolis.  She isn’t certain that KanCare will be an improvement over the current Medicaid system, but she’s willing to keep an open mind.

“I guess it has its pros and cons,” Stepanek said. “I think it does have some good points, and the main thing is that our patients get the care that they need.  And that their claims can be paid, and we also need the doctors to be considered.  You know, what is this going to do to them?”

Under the KanCare plan, the private, managed-care companies must reimburse doctors and other healthcare providers at no less than the rates they’re currently receiving under Medicaid.  Mainly, Stepanek says she doesn’t want to see anyone lose access to care. Secretary of Health and Environment Robert Moser says that’s precisely what might have happened without a complete overhaul of the health insurance program funded jointly by federal and state tax dollars.

"If the provider does not choose to participate in all three of the MCOs, and their patients are assigned to the one they did not choose to participate with, either the provider is going to get less reimbursement, or he's gonna lose the patient."

“That’s always been the simple fix, you know, that many governments have gone to when they’re faced with a Medicaid funding issue, is to cut provider rates or reduce the eligibility,” Moser said. “Governor Brownback made the decision to fund Medicaid fully, not to find those savings on the providers’ backs by cutting provider rates, et cetera.”

Proponents say KanCare will save a billion dollars over five years by reducing the growth rate in Medicaid spending. What worries some providers is whether the state and the three companies running KanCare can have all the systems and employees necessary to make it work in place and ready to go by January.  Shirley Gamble is a coding and billing specialist with the Rice County Hospital.

“Are we gonna come up, and in December no one’s gonna get paid for 30 or 90 days, because credentialing’s not done, there’s not staffing to process claims, there’s no one to answer the phone, because all the phone lines are busy? We don’t have enough phone lines coming in,” Gamble said.

Beginning this fall, nearly all Medicaid clients in Kansas will be assigned to one of the three managed care organizations. If clients want to switch — perhaps because their doctor doesn’t contract with the company they’ve been assigned to -- they’ll have 45 days to make the change. Otherwise, they’ll be locked in to that managed care organization for one year—until the next round of “open enrollment.” Gamble worries about what could happen if patients fail to read—and understand—the notices about the group they’ve been assigned to.

"I think it does have some good points, and the main thing is that our patients get the care that they need."

“If the provider does not choose to participate in all three of the MCOs, and their patients are assigned to the one they did not choose to participate with, either the provider is going to get less reimbursement, or he’s gonna lose the patient, and they’re gonna have to go to another provider,” Gamble said.

Dr. Moser says the process is designed to minimize those situations.

“We’ll choose the MCO based on who their usual care provider has signed up with,” he said. “If they’ve signed up with all three, that makes it a little bit easier to choose which managed care company they might be assigned to.”

Moser acknowledges that there’s a lot of work to do in a relatively short time.  He says getting KanCare started right is more important than starting on schedule.

“Oh, certainly!  We’ve said all along, that’s why we have the readiness reviews, is to have a gateway, if you would, that we look at where we’re at at that point in time.  Are we where we need to be to get this up and rolling, and start it out right?  And if we’re not, we will push it back,” he said.

Having said that, Moser thinks everything is still on schedule to roll the program out in January.

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