KanCare

Andy Marso / Heartland Health Monitor

The Medicaid application backlog in Kansas is on its way back up, threatening months of progress on a coverage problem that has vexed health care providers across the state.  

For more than a year, providers that rely on Kansas Medicaid, or KanCare, have been stung by delayed payments as they wait months for eligibility determinations that by federal rule are supposed to take no more than 45 days.

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Medicaid expansion will get hearings in the Kansas House during the upcoming legislative session, the chairman of its health committee says, and leadership assignments suggest the issue may have a more receptive audience than in the past.

Rep. Dan Hawkins, a Wichita Republican who also headed the committee in 2016, says he remains opposed to expanding Medicaid to some low-income non-disabled adults, but his committee will debate the issue.

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Gov. Sam Brownback’s administration has requested a one-year extension of the current KanCare program while delaying a proposal for an updated version of the Medicaid managed care system.

KanCare, which placed all 425,000 Kansans in Medicaid under the administration of three private insurance companies, began in 2013 and is scheduled to expire at the end of 2017.

State officials had planned to make changes to the current contracts and then apply for a long-term extension of KanCare with the federal Centers for Medicare and Medicaid Services at the beginning of 2017.

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Kansas is continuing to do business with a home health care agency that a few weeks ago agreed to settle a federal kickback case for $1.8 million.

State officials say that because the agency, Best Choice Home Health Care Agency Inc. in Kansas City, Kansas, did not admit liability as part of its settlement with the government, the state’s hands are tied.

Jim McLean / Heartland Health Monitor

An analysis of KanCare performed by a former Republican governor’s think tank found that the switch to managed care Medicaid in Kansas has delivered on cost-cutting promises but not on quality of care.

Leavitt Partners, a policy consulting shop founded by former Utah Gov. Michael Leavitt, performed the analysis between May and October by interviewing KanCare providers and reviewing federal and state data.

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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.

Andy Marso / Heartland Health Monitor

The employees of Cornerstone Supports gathered last week at a house in Olathe with their clients — adults with intellectual and developmental disabilities — to plan their last day together.

Cornerstone, based in Olathe, will close later this month, and its 19 clients will have to find other companies to help them with daily tasks so they can stay in their own homes.

The regular gatherings at the Olathe house where three Cornerstone clients live will end Oct. 28.

“We should do something,” said Brandon Thompson, one of the clients.

Alex Smith / Heartland Health Monitor

At his apartment in Olathe, Kansas, 42-year-old Nick Fugate catches up on washing dishes and remembers the 22 years he spent doing it at a local hotel, trying to stay on top of a never-ending-stream of plates, glasses and silverware.

Nick recalls minor annoyances like the long days, the hot kitchen and his fingers pruning in the water. It could be tedious, but he says he didn’t really mind.

“Just as long as I got the job done, it was fine,” Nick says.

Megan Hart / Heartland Health Monitor

Several Kansans are scheduled to meet Tuesday with federal officials and counterparts from across the country to discuss issues related to the privatization of state Medicaid programs.

Courtesy John Fales

The president of the Kansas Dental Association said he has stopped taking patients from two of the state’s three KanCare insurance companies because of a 4 percent Medicaid reimbursement cut initiated by Gov. Sam Brownback’s administration.

John Fales, a pediatric dentist from Olathe, said Scion — the dental benefits manager for United HealthCare and Amerigroup — has told him it will implement the cut before it is approved by the federal Centers for Medicare and Medicaid Services.

Stormont Vail Health of Topeka is closing two regional clinics because of financial pressures created by recent cuts in Medicaid reimbursements and the decision by state leaders not to expand the health care program.

Stormont will close Cotton O’Neil clinics in Lyndon and Alma, according to a news release issued Thursday. The Lyndon clinic will close Dec. 31. The clinic in Alma will close Jan. 31, 2017.

Andy Marso / Heartland Health Monitor

Like most moms, Judy Talbot has photos and videos of her daughter on her smartphone.

But some of the images Talbot keeps on her phone show her daughter smacking herself in the face repeatedly or strapped to a bed, writhing against restraints with bruises up and down both legs.

“From her kicking,” Talbot explained.

Talbot’s daughter, Jill, is 32 and has autism and post-traumatic stress disorder.

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Facing increasing criticism from health care providers about recent cuts in Medicaid reimbursement rates, Gov. Sam Brownback said that he will attempt to restore the cuts by increasing a tax that hospitals pay.

In a statement issued Wednesday afternoon, Brownback said he was forced to order a 4 percent cut in provider reimbursement rates in May after efforts to negotiate an increase in the surcharge failed.

Andy Marso / Heartland Health Monitor

The leaders of some Kansas community mental health centers say they are having trouble getting paid for some Medicaid services they believe their clients need.

Brenda Mills, CEO of Family Service and Guidance Center, a Topeka-based community mental health center that serves children, spoke Thursday at a meeting of the Robert G. (Bob) Bethell Joint Committee on Home and Community Based Services and KanCare Oversight.

Susie Fagan / KHI

Supporters of Medicaid expansion are kicking off a campaign to mobilize Kansas voters on the issue. Federal tax rules prohibit the nonprofit Alliance for a Healthy Kansas from engaging in direct political activity, so the group is mounting a vigorous educational campaign through a series of community meetings across the state. 

Andy Marso / Heartland Health Monitor

Kansas tax collections for May fell short of projections by about $74 million, and legislators said Wednesday they fear that will mean more cuts to Medicaid.

The May shortfall comes despite the state’s revenue estimating group revising projections downward for the third consecutive time about six weeks ago.

It wipes out the meager savings Gov. Sam Brownback created when he made cuts two weeks ago after the Legislature sent him a budget that didn’t balance.

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Kansas health care providers will urge federal officials to reject Gov. Sam Brownback’s proposed Medicaid cuts and may challenge them in court.

The recently announced cuts would reduce state expenditures for KanCare, the state’s privatized Medicaid program, by $56.3 million and trigger a loss of approximately $72.3 million in federal funds. Combined, the managed care organizations that administer $3 billion KanCare program and the health care and service providers they have contracts with would be forced to absorb more than $128 million in cuts.

Bryan Thompson / Heartland Health Monitor

State officials on Thursday wrapped up a series of public forums on the pending renewal of KanCare, the state’s privatized Medicaid program.

Federal approval for the five-year demonstration project expires at the end of 2017, and the Kansas Department of Health and Environment plans to apply for reauthorization by the end of this year.

Forum organizers were looking for ideas about coordination of care, value-based payment systems and waiver integration.

Andy Marso / Heartland Health Monitor

A proposal to reimburse some KanCare providers at a higher level based on patient outcomes drew skepticism from a crowd of hundreds who gathered Tuesday afternoon in a Topeka hotel ballroom.

Tuesday’s public meeting was the first in a series that state officials are hosting as they prepare to renew their federal application for KanCare, the state’s $3 billion managed care program that privatized all Medicaid services under three insurance companies in 2013.

Similar gatherings are scheduled Wednesday in Kansas City, Kan., and Wichita and Thursday in Pittsburg and Hays.

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This story was updated at 8:30 p.m.

Gov. Sam Brownback trimmed more than $56 million from Medicaid in Kansas as part of larger budget cuts announced Wednesday, raising concerns that health care providers may decide not to take unprofitable patients.

About $38.2 million of the $56.4 million in budget cuts comes from reducing reimbursements by 4 percent for providers who treat patients covered by KanCare, the state’s privatized Medicaid program launched in 2013. The remaining $18.2 million comes from cuts in other areas of the Medicaid program.

State officials have scheduled five meetings to gather public comment on KanCare in advance of renewing contracts to administer the state’s privatized Medicaid program.

The contracts currently held by UnitedHealthcare, Amerigroup and Sunflower State Health Plan (a subsidiary of Centene) expire in 2018. Those private insurance companies serve as managed care organizations that operate KanCare.

Susan Mosier, secretary of the Kansas Department of Health and Environment, said her agency wants to hear from the public on what to include in the next contracts.

Courtesy Bill Stovall

A statewide registry is in the works to make it easier for Medicaid patients to find qualified, reliable personal care workers.

That’s good news for Bill Stovall of Topeka and others like him who help direct care for their family members.

Stovall has a long list of complaints against personal care workers who have cared for his sister in recent years, including punctuality problems and a lack of training.

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Federal officials are concerned about a growing backlog of Kansas Medicaid applications and have asked state leaders to provide regular updates about what they're doing to fix the problem.

James Scott, associate regional administrator for the federal Centers for Medicare and Medicaid Services sent a letter to Kansas Department of Health and Environment officials Feb 17, citing concerns about “recent reports" of the Medicaid application backlog in the state of Kansas.”

Scott asked KDHE to submit within 14 days a plan to correct the backlog.

Andy Marso / Heartland Health Monitor

Judy Kregar is not a member of the Rotary Club in nearby Greensburg, but she decided to go when she heard Gov. Sam Brownback would be at the club’s recent meeting.

Kregar, the administrator of a small nursing home in nearby Bucklin, wanted to tell Brownback in person about the struggles some of her residents are having getting their Medicaid applications and annual renewals processed.

 Kansas is seeking a renewal of the Medicaid waiver for its KanCare program. As the federal government decides whether to grant the waiver, we discuss  future ideas to streamline the program and how well it provides healthcare for the most vulnerable Kansans. 

Guests:

  • Tim Wood is director of the Community Developmental Disabilities Organization for Johnson County.
  • Kari Bruffett is the policy director for the Kansas Health Institute.
  • Dan Margolies is KCUR's Health Editor.

Andy Marso / Heartland Health Monitor

The state’s $3 billion privatized Medicaid system has been without an inspector general for more than a year. The Kansas Senate unanimously approved a bill Wednesday that would eliminate the position.

Andy Marso / Heartland Health Monitor

Thousands of Kansans seeking Medicaid benefits are being forced to wait months because of continuing problems with a new computer system and a change in the state agency responsible for handling some eligibility determinations.

Jim McLean / Heartland Health Monitor

Officials from Lawrence Memorial Hospital returned Friday to the Statehouse armed with details about ongoing problems they’re having with the companies that manage KanCare, the state’s privatized Medicaid program.

A panel of legislators Friday reversed their recommendation of a lifetime ban on hepatitis C drugs for Medicaid patients who don’t comply with their treatment regimen.

Members of the Joint Committee on Home and Community Based Services and KanCare Oversight walked back on the recommendation they made in December  after hearing from Mike Randol, who heads the Kansas Department of Health and Environment’s Division of Health Care Finance.

KHI News Service

A key member of Gov. Sam Brownback’s new rural health working group says he hopes the initiative is a serious effort to address problems facing rural providers, not an attempt to divert attention from a renewed push to expand the state’s Medicaid program.

Republican Rep. Jim Kelly represents Independence, the southeast Kansas community that recently lost its only hospital due to budget problems exacerbated by federal reductions in Medicare reimbursement rates and the state’s rejection of Medicaid expansion.

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