Kansas was out in front of just about every other state in 2013 when it fully privatized its Medicaid program and renamed it KanCare.
The switch to managed care was one of the first big policy changes made by Gov. Sam Brownback, who promised it would both improve health care and lower costs.
KanCare was immediately controversial.
Some beneficiaries complained to lawmakers about having to fight efforts by the for-profit managed care organizations to reduce their services. Legislators also started hearing complaints from hospitals, doctors and other health care providers, who said they were having trouble getting paid on time and getting the MCOs to authorize certain tests and treatments.
Despite the complaints, Brownback touted KanCare as a success in his 2017 State of the State address to the Legislature.
“We’ve seen more Kansans served than ever before, steady or improving health outcomes for beneficiaries, and dramatic cost savings to taxpayers in the amount of nearly $1.4 billion,” Brownback said.
KanCare hasn’t reduced Medicaid costs, but it has slowed their rate of growth.
But providers say a study done late last year shows that those savings have come at a cost to them and their patients.
“If you would make that statement to a health care provider: ‘KanCare has met its cost cutting goals, hasn’t it?’ the provider would say, ‘They might have, but I can tell you how they did it and that is by not paying me on time or not paying me at all,’” said Tom Bell, president of the Kansas Hospital Association.
Quality Of Care Affected
KanCare provides health insurance to about 425,000 children and low-income, disabled and elderly adults.
More than a third of the kids that pediatrician Dennis Cooley sees in his Topeka office are covered by KanCare. He said dealing with three managed care organizations, each with its own set of rules, has made caring for those patients harder than it used to be under the old system.
“It’s a struggle certainly for our staff,” Cooley said. “Some of the problems include things like prior authorizations. I’ve had nurses who have sat on hold for two hours waiting to just get somebody to respond to them.”
That affects patients, Cooley said.
“Because the patients may have to wait to get a procedure like an MRI or something that maybe they should get quickly,” he said, adding that getting the MCOs to authorize certain medications can “also be a struggle.”
Hospitals are also complaining about increased red tape. Bob Finuf is a vice president at Children’s Mercy Hospital, in Kansas City, Mo., where one of every five patients is covered by KanCare.
“We’re providing over 100,000 patient encounters for KanCare recipients each year, and for that we’re subsidizing the program to the tune of $60 million to $65 million annually,” Finuf said.
He said low reimbursement rates and increased administrative expenses are making it difficult for the hospital to serve KanCare patients.
“Unfortunately it has gotten to a point where we have to start asking ourselves how long can you continue to provide the breadth and depth of services to KanCare (patients) without adequate reimbursement, especially when you layer on top of that extreme administrative burdens,” Finuf said.
Lawmakers Stepping In
Some lawmakers are tired of hearing complaints about KanCare from doctors and hospital administrators in their districts. They’re working on a measure that would require the managed care organizations to standardize some of their business practices, such as credentialing providers. It also would establish an independent review process to settle disputed claims.
Sen. Barbara Bollier, a Mission Hills Republican, is leading the charge on the Senate Public Health and Welfare Committee.
“It’s our responsibility (as legislators) to supervise and police administrative programs and make sure they’re really doing what we need for our citizens,” she said. “And if not, we need to make the changes.”
The MCOs and the Brownback administration don’t want the proposed administrative fixes cemented into state law. They would rather tweak language in the KanCare contracts or in the rules and regulations written and enforced by the Kansas Department of Health and Environment, the state agency that oversees the contracts.
Shawn Sullivan, director of Brownback’s budget office, said lawmakers should set the bill aside and wait on recommendations from a new task force formed by Lt. Gov. Jeff Colyer.
“Their goal is to spend the next several months working through the process of credentialing, billing — trying to look at what could be more consistent between the three managed care companies — and putting together an execution plan for how to make that happen,” Sullivan said.
But members of the Senate committee working on what some are calling the “KanCare fix bill” say they’ve heard similar promises before.
“They (the administration) have had opportunity after opportunity to enforce the regulations and the contractual arrangements that they had. They didn’t do it and so now I think it’s time for us to take it over,” said Sen. Laura Kelly, the top Democrat on the health committee.
The KanCare bill is among those scheduled for debate before this week’s deadline for moving bills out of the legislative chamber in which they were introduced.
Jim McLean is managing director of KCUR’s Kansas News Service, a collaboration of KCUR, Kansas Public Radio and KMUW covering health, education and politics in Kansas. You can reach him on Twitter @jmcleanks. Kansas News Service stories and photos may be republished at no cost with proper attribution and a link back to kcur.org.