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.
“We’ll just have to dismantle everything. I’m not sure it’s feasible to do it twice,” says Krista Postai, chief executive of the Community Health Center of Southeast Kansas, a safety net clinic based in Pittsburg but with satellites in nearby towns. "That final-hour thing is really quite shocking. I'm not used to dealing with anything like this. This was a first for us."
The clinic, after months of discussion, was planning a partnership with its counterpart in Johnson County. Together they would provide health home services in 18 eastern counties with the expectation they would serve thousands of chronically ill poor people with the wraparound services and close case management that are the hallmarks of health homes.
But as of Monday afternoon that plan began unraveling. Postai and other providers received a short email alerting them that officials at the Kansas Department of Health and Environment had decided that the part of the initiative dealing with Medicaid enrollees who are chronically ill with asthma or diabetes was being indefinitely delayed and would be re-evaluated as an option after Jan. 1, 2015. Officials said there wasn’t an adequate network of providers to begin Monday, as previously scheduled.
More than half the 72,000 people estimated to be eligible for the health homes program, which is paid for 90 percent by the federal government, are estimated to fall in that chronically ill category.
As late as last week, KDHE officials were still saying publicly that they planned to mail letters today to eligible, chronically ill Medicaid enrollees telling them they were going to be included in the initiative unless they opted out.
But apparently at the last minute, top officials at KDHE concluded there weren’t enough providers of the right types to launch the program statewide as initially planned. The portion of the program targeting Medicaid enrollees with serious mental illness, about 36,000 people, so far is proceeding on schedule with their notice letters sent this week and services beginning Aug. 1. The announcement marked the second major delay in the program, which administration officials originally had said would start Jan. 1 this year.
“The secretary along with everyone at KDHE is conducting readiness reviews on a regular basis to make sure our network was thorough. We concluded we really needed to do a better job on educating providers and to get more providers in the fold on this,” says Sara Belfry, an agency spokesperson. "We did communicate to (providers) that it was going to be delayed. We communicated as quickly as we could.”
But that turned out to be less than 24 hours' notice.
“We were shocked to find out one day in advance that we weren’t going to have a program,” says Jason Wesco, chief executive of the Health Partnership Clinic in Olathe, the planned health homes partner with the Community Health Center of Southeast Kansas. “I don’t know what the magic of January (the re-evaluation date) is. I don’t know that any more providers will be willing to jump in now. … The fact they pulled the plug on it makes me think it’s never coming back.”
Wesco says he had hired a project director for the health homes initiative and was interviewing people for five new care coordinator positions. Now, he says, he'll cancel the new hires and try to figure out how he can afford to keep the new project director.
"I don’t make commitments to people I don’t keep, so I’m in the process of figuring that out," he says. "She left a good job specifically to do this work. So, I don’t know exactly what I'm going to do. I'll figure out something."
Other providers across the state also have hired new workers or were in the hiring process, and some leased or expanded space in anticipation of the initiative.
“We definitely think there’s going to be an impact on our clinics that have hired staff and have geared up to be trained ready to start in August, and with the pushback (indefinite delay) they’re definitely going to feel the impact of it,” says Katrina McGivern, a spokesperson for the Kansas Association for the Medically Underserved, the association that represents the state’s safety net clinics. “It did come as a big surprise to us.”
But some of the safety net clinics had already chosen a go-slow approach because they were uncertain what the future of the program might be.
“Our approach was that we were going to start with the patients that we were the primary care provider for and build the network out from there as we could. Thanks goodness we took that approach,” says Bryan Brady, chief executive of First Care Clinic in Hays. “I think it’s strange how quickly it happened, because it was no sooner than we got off a webinar (about the health homes initiative) with one of the (KanCare managed care companies) that the email went out saying the chronic conditions model was being delayed. There was the webinar (Monday), then an hour later it was off.”
Belfry says KDHE still intends to proceed with the health homes program for the chronically ill, but not until the network of providers is sufficient to provide the full range of services in each county and with enough of them so that each enrollee will have a choice of at least two providers.
“It’s not really an if question,” she says. “It’s a when. We are going to do this. We have been looking at the health homes concept for years. We needed the readiness review to assure we had the providers in place. We didn’t feel we had the network adequacy.”
But state officials may find that the delay will only make it more difficult for them to bring providers on board because of the misfire, Postai and others say.
“If it comes up again, we’ll revisit (our plans to participate). But I’m not sure I’ll invest the energy level I did before because I can’t trust it will happen,” Postai says. “I’ve lost faith it will ever happen. We’re as close now as we’ve ever been. The momentum was built. My staff was enthused. I was enthused. It would have led to bigger and better things. But it is what it is, and something big obviously kept it from happening.”
Mike Shields is managing editor of KHI News Service, an editorially independent reporting program of the Kansas Health Institute.