The Kansas Medicaid system is in serious trouble with the federal government. And that’s an important warning sign for the state, and the nation.
In mid-January, the Centers for Medicare and Medicaid Services told the state that KanCare, its largely private system for providing health care for the poor, has several critical deficiencies.
KanCare patients have clashed with the state over coverage questions, investigators found. Record keeping has been poor. State oversight has been lacking. Treatment plans often have been incomplete. Access to health care has been threatened.
The problems are so significant the federal government said it won’t renew KanCare’s waiver — essentially, its permission slip — beyond the end of the year.
Predictably, Kansas officials grumbled. Lt. Gov. Jeff Colyer called it an “ugly parting shot from the Obama administration,” although he didn’t explain why Kansas was singled out for such approbation. He also said the Trump administration would be friendlier to the state.
We’ll know in a few weeks what the White House plans to do and if CMS will reconsider its decision. The 425,000 Kansans who get health care through KanCare will be watching closely.
We are not reflexively opposed to privatized Medicaid services. Thirty-nine states, including Kansas and Missouri, use private managed care organizations to provide at least some health care for Medicaid patients.
The idea is simple: By coordinating traditional private medical services with counseling, wellness advice, early detection and other programs, states can keep costs down while making patients healthier. That’s good for clients and for taxpayers, too.
As always, though, execution is more important than design. And KanCare’s results, now four years in, have been disappointing.
Some patients, notably the disabled, say the system is underfunded and difficult to navigate. The private insurers have lost millions. Providers have seen their reimbursements cut, leading them to take fewer patients.
And now comes the federal government’s letter. Kansas needs to fix KanCare’s problems as quickly as possible.
But there’s a larger issue at stake.
Republicans in Congress and President Donald Trump have talked about turning Medicaid into a block grant program. They want to send money to the states, with no strings attached, and let the states decide how to cover poor people who get sick.
Kansas’ stumbles, though, show the potential danger in that approach. Without at least some oversight, states could take their checks, offer substandard care for Medicaid patients and walk away.
More than two dozen Kansas health care groups recently wrote Gov. Sam Brownback, objecting to block grants. Such a system, the groups said, would lead to poor supervision and rationed health care.
Washington is set to overhaul the country’s health system this year. Lawmakers should think hard about plans to write blank checks to states, or KanCare’s problems could become the nation’s.