Facing pressure from both sides of the aisle, Kansas Gov. Sam Brownback announced Wednesday he was scrapping some proposed changes to the state’s Medicaid program, KanCare.
A news release said the decision to postpone KanCare 2.0 addresses legislators’ concerns about potential cost increases.
“We will continue to listen to participants and providers and work with the legislature to ensure we are increasing the quality of care and outcomes under KanCare,” said Lt. Gov. Jeff Colyer, a plastic surgeon who has been Brownback’s point person on KanCare.
The decision will leave case management for Kansans with disabilities as is. But the Brownback administration said it still plans to pursue work requirements for a small portion of the state’s 425,000 KanCare recipients. Most of them are children, frail and elderly residents, pregnant women or disabled people who would not be required to work to maintain their benefits.
Meanwhile, the state has promised to redouble efforts to improve a Medicaid application process plagued by long delays.
The announcement caused some confusion among legislators and stakeholders, who said it was a surprise that brought more questions than answers in the final year of the current KanCare contracts.
Angela de Rocha, a spokeswoman for the Kansas Department of Health and Environment, said the department will try to amend, rather than withdraw, its application to the federal government to continue KanCare, the Medicaid privatization that Brownback and Colyer spearheaded in 2012.
The department will request a three-year extension of the contracts it signed that year with Amerigroup, Sunflower State Health Plan (a subsidiary of Centene) and UnitedHealthcare. If it doesn’t get that, it will enter into new contracts with companies that won’t increase KanCare’s budget, which is about $3 billion in state and federal money.
“My issue with this is, I don’t know all the specifics of what that exactly means,” said Kansas Sen. Barbara Bollier, a Republican from Mission Hills.
Bollier said staying budget-neutral seems to be at odds with moving forward on work requirements, which would take more staff and money to enforce.
But De Rocha said the only thing that’s definitely off the table is the changes to case management, which had vexed disability advocates and legislators.
Kansas Rep. Dan Hawkins, a Republican from Wichita who is chairman of the House Health and Human Services Committee, said the administration’s plan to move independent case managers under the three KanCare companies was opposed by Republicans, who saw it as too expensive. Democrats saw it as a potentially harmful policy.
“Throw them both together and it’s a pretty formidable opposition to moving ahead with KanCare 2.0,” Hawkins said.
Hawkins said adding work requirements is also far from a sure thing, even though Kansas is one of 10 states that have already requested federal approval to do it.
“There’s legislation coming out that will probably pare that back,” Hawkins said.
David Jordan, the executive director of the Alliance for a Healthy Kansas, said work requirements would add KanCare costs for enforcement and legal fees.
Kentucky, the first state to get federal approval to add them, has already been sued.
“Rather than confuse and complicate the situation, the administration should officially withdraw KanCare 2.0 from federal consideration and get to work with enrollees, families, and other partners on improving the current KanCare program,” Jordan said.
The news release said the state is trying to improve the current program, starting with a crackdown on Maximus, the contractor that staffs the Medicaid eligibility center in Topeka.
The center, called the “KanCare Clearinghouse,” has for years been plagued by delays in application processing that have forced Kansans to wait months for coverage and financially squeezed nursing homes that rely heavily on Medicaid reimbursement.
In a hearing in Topeka last week, several nursing home representatives testified that it was harming their bottom line, something they’ve done repeatedly since Maximus took over at the beginning of 2016.
Hawkins told them he shared their concerns, but that he believed the new secretary of KDHE, Jeff Andersen, was serious about finally fixing the problem.
De Rocha said the state has sent a “letter of non-compliance” warning Maximus that KDHE will begin levying financial penalties for every delayed application.
“That’s one of the things people are really not happy with,” de Rocha said. “We understand that and are trying to fix it.”
Two Maximus spokespeople did not respond to requests for comment.
Sean Gatewood, the co-administrator of the KanCare Advocates Network, said the letter was a welcome step that the state should have taken years ago.
Gatewood said everywhere state officials went to talk to the public about KanCare 2.0, they were instead besieged by complaints about how hard it was to get into KanCare in the first place.
“Trying to launch something in the middle of this eligibility crisis that’s been going on for several years was probably never going to work,” Gatewood said. “Because that’s not what anybody wanted to talk about.”
Gatewood said there’s still a lot of uncertainty over how KDHE plans to proceed. But it seems clear that the state botched the roll-out of KanCare 2.0 by putting it forth without enough specifics.
“There’s just not a clear plan of what the state intended to do, so that freaked out everybody,” Gatewood said. “There wasn’t a financial plan: we estimate this is how much this is going to cost, and here’s how much this is going to cost. I’m hoping that KDHE sort of goes back and looks at these issues.”