Kansas legislators are discussing a bill to remove services for those with intellectual or developmental disabilities from KanCare for the first time since the fully privatized Medicaid program began in 2013.
But the discussion quickly hit a snag during last week’s hearing on Senate Bill 332: Even groups that agree the private KanCare companies shouldn’t be in charge of administering the services don’t agree on who should be.
That leaves legislators uncertain about how to proceed.
“There are a lot of different opinions on it,” said Kansas Sen. Vicki Schmidt, a Republican from Topeka who is chairwoman of the Senate Public Health and Welfare Committee. “There’s kind of some conflict within the (disability) community.”
Under KanCare, or Kansas Medicaid, people with disabilities who might otherwise be institutionalized can get in-home or community-based help with everything from bathing and dressing to job assistance.
As part of a series of stories on government transparency last year called Secret Kansas, The Star reported that caregivers and case managers say the process of getting and keeping services has become less transparent and more confrontational since KanCare started. Some said the KanCare companies had asked them to sign blank plans of care only to later find out services were cut.
Families for KanCare Reform, a group of caregivers from Johnson County, supported the Senate bill by making a video that featured several families talking about having services cut or coverage denied.
“I and others believe that KanCare has created a bureaucracy that hinders the quality of services and supports our loved ones depend on to live in their communities,” said Ron Fugate, one of the group’s leaders.
Fugate’s group says the KanCare companies have an incentive to reduce disability services because they are paid a flat rate and get to keep what they don’t spend.
Only about 8 percent of the 430,000 Kansans on Medicaid receive the daily support services, but they make up about one-third of the state’s Medicaid expenses, which run to about $3 billion a year.
The three KanCare companies — Amerigroup, Sunflower State Health Plan and UnitedHealthcare — and the Kansas Department of Aging and Disability Services, said the current system is working and shouldn’t be changed.
KDADS, part of the administration of Gov. Jeff Colyer, has said in the past that the KanCare companies should not have asked caregivers to sign blank plans of care and it will work with them to end the practice.
But KDADS director of operations Brad Ridley said overall the privatization of disability services is going well. He said although some people have seen reductions in services since KanCare, others have seen increases and the state is spending more on them than before.
The Senate bill would take the companies out of the equation and turn the administration of disability services back to a network of 27 Community Developmental Disability Organizations, or CDDOs, across the state. The organizations are non-profit or county agencies that evaluate Kansans to see if they qualify for services based on their disabilities.
But several providers of disability services said that while they don’t necessarily support KanCare, they oppose going back to a system in which the CDDOs decide who should get services and what providers to refer them to.
That’s because many of the CDDOs also provide disability support services themselves. That presents a conflict of interest that gives them an inherent advantage over other providers, said Jamie Price, the senior vice president of Community Living Opportunities in Lenexa.
Price said her company and other service providers hadn’t been consulted on the bill. She urged senators to set it aside, study other states and work out a new, “conflict-free” system.
“I think we need to bring stakeholders to the table and have a conversation,” Price said.
That wasn’t the only suggestion. Other groups said the bill was too narrow and suggested that it be amended to carve Kansans with other types of disabilities out from KanCare as well.
Schmidt said she didn’t know whether the Senate bill would get a vote.
She said she’d seen some encouraging signs from the KanCare companies, including a workgroup Sunflower State started with case managers last year to try and improve its administration of disability services.
Kansas Sen. Laura Kelly, the top Democrat on the health committee, said her preference would have been to keep the disability services out of KanCare from the beginning. But now, given the disagreements within the disability community, more thought and planning should be given to what comes next.
“Bring them all together,” Kelly said, “and let’s see if we need to throw the baby out with the bathwater or if we can clean up the bathwater.”