TOPEKA — Gov. Sam Brownback’s administration on Friday unveiled proposed changes to the Medicaid program in Kansas featuring a unique work mandate applicable to 12,000 participants, in anticipation a job would improve their health status and sense of self-reliance.

Recommendations for adjusting KanCare will undergo a 30-day public comment period and must be approved by the federal government before introduced to low-income elderly people, individuals with disabilities and children in poor families on Jan. 1, 2019.

Brownback handed off management of the state’s Medicaid system serving 400,000 people to three private insurance companies in 2013, inspiring years of debate about health policy, personal outcomes, lack of oversight and cost savings.

Under the new proposal, some adults enrolled in Medicaid would be subject to work rules that exist for those getting cash welfare assistance under Temporary Assistance for Needy Families. Restrictions imposed by state lawmakers on TANF recipients cut enrollment by thousands of people.

“TANF has got 40,000 people off welfare and into employment,” said Angela de Rocha, a spokeswoman for the Kansas Department for Aging and Disability Services. “There is no down side to work requirements. It’s good for their quality of life.”

The 20-hours-per-week work requirement would apply to able-bodied adults in Medicaid with children older than 6 years of age. Excluded from the work edict would be people in state hospitals or long-term care, pregnant women, children and individuals in home- and community-based services programs directed at intellectual and developmental disabilities, autism, serious emotional disturbances, frail elderly and traumatic brain injury.

David Jordan, executive director of the Alliance for a Healthy Kansas, said Kentucky and Arizona already have sought authorization for a work mandate under Medicaid. Such a requirement never has been accepted by the federal Centers for Medicare and Medicaid Services. If the administration of President Donald Trump approved, he said, opponents likely would file lawsuits.

“A work requirement is viewed as illegal. It’s in conflict with federal law,” Jordan said. “There is one goal of work requirements. It’s to reduce access to services.”

KDADS Secretary Tim Keck was joined at a Statehouse news conference by Susan Mosier, secretary at the Kansas Department of Health and Environment, to explain ideas for KanCare 2.0. In early October, the federal government reversed a decision blocking Kansas’ request for a one-year extension of KanCare. The extra year allows the state to enter contracts with managed care companies for the second phase of KanCare.

“In the long run,” Keck said, “we believe it will lower costs.”

The Brownback administration implemented KanCare in 2013. State officials said the reform made it possible to bend the cost curve in a $3.4 billion annual program.

Mosier said the new model would emphasize pilot programs to improve placement of foster children, noting one child in Kansas moved 42 times in one year. She said another initiative would seek to reduce reliance on psychotropic medications given to children in state care.

Public comment forums are scheduled Nov. 14 to 20 in Topeka, Olathe, Dodge City, Great Bend, Pittsburg and Wichita.

Advocates for the disabled complain that operation of KanCare by three managed-care organizations has been plagued by lack of government oversight and that the administration’s opening salvo didn’t suggest a change in tone.

“The devil’s in the details,” said Sean Gatewood, who works with KanCare Advocates Network. “The MCOs have all the power.”

The proposed new KanCare plan can be reviewed on the KanCare website at www.KanCare.ks.gov. It will build on the original KanCare formula that simplified program offerings and will improve quality of care, said Lt. Gov. Jeff Colyer.

“KanCare 2.0 builds on the successes we’ve had in the past in order to continue serving our most vulnerable citizens, assisting them with services that benefit their physical health and improve their quality of life,” he said.