When it comes to KanCare, the state’s privatized Medicaid system, frustrations seem nowhere close to going away.
In Sabetha, Kan., Jody Reel and her husband own a pharmacy and do their own plumbing because they can’t afford a plumber.
That part they can understand — if you own a small business, sometimes you have to be flexible.
But what troubles her is how changes in Kansas to the Medicaid program have made things more difficult for both her and her customers. Because of those changes, she said, she’s technically losing money on every Medicaid prescription.
Her store loses money, she said, and isn’t able to offer the free services to patients that it used to.
“We do what we can, but at the end of the day we still have to be able to keep the lights on and pay our employees,” said Reel, who also is chairwoman of government affairs for the Kansas Pharmacists Association.
Those frustrations were echoed Thursday by health care providers during a legislative KanCare oversight meeting in Topeka. And they were further bolstered by a report commissioned by three health care groups that criticizes KanCare for not living up to earlier promises, a critique Gov. Sam Brownback’s administration dismissed in an emailed statement.
KanCare started in 2013 as the state’s privatized Medicaid program. The report, which came from government documents and interviews with health care providers, also recommended that the state become more involved in KanCare.
The review was completed by Leavitt Partners, a firm created by former Utah Gov. Michael Leavitt. He has also served as secretary of the U.S. Department of Health and Human Services.
“Providers are not saying, ‘We’re fed up, we don’t want to help improve this,’ ” said Robin Arnold-Williams, a member of the firm. “They’re saying, ‘We’re ready to improve this system. We want it to be the best it can be for Kansans who are on Medicaid.’ ”
As the state dealt with budget problems earlier this year, Brownback cut reimbursement rates to many KanCare providers by 4 percent.
That $56.4 million Medicaid cut helped balance the state’s budget, but was pointed to frequently Thursday as a sore spot for health care providers struggling to get by. Though they also criticized other aspects of the program, including administrative burden, the cut for providers kept coming up.
Eileen Hawley, the governor’s spokeswoman, said in a statement that the administration planned to testify about KanCare during the oversight committee’s meeting on Friday.
“KanCare has met its original care goals, including improved health outcomes, as well as its financial goals,” Hawley said in an email. “The referenced report interviewed providers only; they did not interview beneficiaries. The actual data show that primary care, dental, vision, transportation, and home and community based services have increased.”
Tim DeWeese, director of the Johnson County Mental Health Center, told the committee that before KanCare he had more than 400 employees. Only a third of his budget was funded by the county. And around 12,000 people in the county were served.
Now, he said, he has 114 fewer staff members, he serves 2,100 fewer people in the county and the budget is now close to 60 percent funded by the county.
Johnson County has been able to push that funding burden to itself, DeWeese said. Less wealthy counties likely wouldn’t be able to do the same.
“That’s not the direction that we need to be heading,” DeWeese said. “We’re growing every year. And we need to be providing more services.”
Rep. Dan Hawkins, a Wichita Republican who is chairman of the KanCare oversight committee, said the 4 percent cut has been devastating in the state. Reversing that is a top priority for the next legislative session, Hawkins said. He worries about what would happen to health care access for patients if the Legislature isn’t able to do so.
“That has to be rolled back,” he said.
The state is already facing a projected budget shortfall of nearly $350 million this year. A larger shortfall of $582 million is expected for the 2018 fiscal year.
The outlook doesn’t look to be getting better in the months to come, Rep. Jim Ward said Thursday. The Wichita Democrat pointed to the state’s financial shortfalls this year and next year as reason for concern. And he asked health care providers how they would handle more cuts, if they were to come.
“I don’t think there’s any question that more is coming,” Ward said. “We’re (roughly) a billion dollars under water, and I haven’t heard a real good idea from the governor’s office in six years, so I don’t expect to see a solution quickly. ... What impact will that have if there’s another provider cut?”
After mulling it over, Denise Cyzman, executive director of the Kansas Association for the Medically Underserved, said it could lead to fewer patients being served and clinics having to close their doors.
“It’s frightening,” she said.