Healthier model

On Nov. 8, I joined Gov. Sam Brownback and Lt. Gov. Jeff Colyer in announcing reforms that will sustain Medicaid in Kansas and facilitate integrated, whole-person care for the state's most vulnerable populations. The catalyst for achieving these positive results is KanCare -- a plan that demonstrates the administration's commitment to improving outcomes for Medicaid consumers and curbing the cost of the program, all without scaling back eligibility or cutting rates for health care providers.

To better serve Kansans, we are seeking a waiver from the Centers for Medicare and Medicaid Services. The concept paper for that waiver was sent to CMS on Jan. 26, and my agency is receiving public comments now through the end of February. The waiver will enable Kansas to implement four major initiatives to improve Medicaid: 1) move all Medicaid populations into an integrated, person-centered care model; 2) cover all Medicaid services, including long term support services, through that model; 3) establish safety net care pools to ensure access to essential hospital services; and 4) create and support alternatives to Medicaid.

In my meetings with health care providers, advocacy groups and consumers, there is a shared sentiment that the current system is not sustainable and that care for Medicaid beneficiaries is fragmented. The public input forums held last year throughout the state were well-attended, and I appreciate everyone who took time to participate in person and those who wrote to us their suggestions for remaking Medicaid. Tackling the structural deficit facing Medicaid cannot be accomplished by excluding or focusing solely on one population or service. Also, no short-term solutions -- provider rate cuts, tweaks of eligibility requirements or reducing services -- will address the scale of the issue over time.

The state is focused on an integrated, whole-person care system and creating health homes for those with diabetes, chronic mental health conditions or both. KanCare will preserve or create a path off Medicaid to independence and help develop alternative access models, care coordination and an emphasis on home- and community-based services. Kansas provides Medicaid services to more than 380,000 Kansans. HealthWave (serving women and children) is a managed care program that already provides services for nearly two-thirds of the Medicaid and Children's Health Insurance Program population. Under KanCare, the state will expand care management to all Medicaid populations, including the aged and disabled, by Jan. 1.

Services for Kansans with developmental disabilities will continue to be provided under the auspices of Community Developmental Disability Organizations, but their inclusion in KanCare means the benefits of care coordination will be available to them. KanCare companies will be accountable for functional as well as physical and behavioral health outcomes. By bringing in additional resources, the KanCare health plans will help provide enhanced care coordination for Kansans with developmental disabilities. Our goal is to improve access to health services and continue to reduce disparities in life expectancy while preserving services that improve quality of life.

Because these reforms were driven by Kansans, the state will form an advisory group of persons with disabilities, seniors, advocates, providers and other interested Kansans to provide ongoing counsel on implementation of KanCare. Additionally, KanCare companies will be required to create member advisory committees to receive regular feedback and have member advocates to assist other members who have complaints or grievances.

The waiver concept paper submitted on January 26 begins discussions with the federal government about the policies needed to implement KanCare, but in it Kansas also requests a second track of discussions, with the long-range goal of fundamentally reshaping Medicaid. That future global waiver would, as we propose it, redefine the federal-state relationship in Medicaid and focus even more on outcomes and healthier Kansans.

Robert Moser, secretary and state health officer, Kansas Department of Health and Environment