TOPEKA — Individuals and associations representing enrollees in Kansas’ Medicaid program shared frustration Monday with difficulty securing services for thousands of people eligible for assistance as well as with Gov. Sam Brownback’s declaration of policy victory for saving the state treasury $1.4 billion after turning the system over to three insurance companies.
“If we are saving so much money with KanCare, why do we still have a waiting list of seven to eight years?” said Roxanne Hidaka, an Overland Park representative of Case Management Services.
Hidaka’s complaint was echoed by Kerry Cosgrove, who provides targeted case management services to people with intellectual or developmental disabilities on the state’s waiting list for home and community-based services. In June, the Kansas Department for Aging and Disability Services reported 3,677 people were on the waiting list for Medicaid programs. Some have been there since 2009, Cosgrove said.
“I strongly believe that anyone who can speak about ‘saving money’ with KanCare when there are still over 3,500 of Kansas’ most vulnerable citizens on the waiting list for services should be ashamed,” Cosgrove said.
Dozens of issues were raised at the Capitol during a hearing of the Kansas Legislature’s joint committee on KanCare oversight. Testimony in support of the KanCare insurance providers and state agencies blended with complaints raised repeatedly through the years.
This inquiry by legislators occurs at a time of transition, with Brownback preparing to leave office and the state applying to the federal government for permission to continue with KanCare, which serves more than 400,000 low-income adults, pregnant women and people with disabilities.
Brownback and Lt. Gov. Jeff Colyer, a surgeon recognized for spearheading development of KanCare, believe services to vulnerable Kansans improved since the program was shifted in 2013 to the Sunflower, Amerigroup and UnitedHealthcare insurance companies.
“We have seen more Kansans served than ever before, steady or improving health outcomes for beneficiaries and dramatic cost savings to taxpayers of $1.4 billion,” Brownback said. “We will continue to be at the vanguard in reform and improvement of our social services delivery.”
In the future, Colyer said many states would adopt a privatized Medicaid model comparable to KanCare. He said Kansas officials were eager to work with the administration of President Donald Trump on authorization of an advanced form of KanCare to be known as KanCare 2.0.
Sean Gatewood, who represents KanCare Advocates Network, told the House-Senate committee problems with eligibility processing backlogs, federal reports showing serious life safety concerns and other factors argued for the 2018 Legislature to indefinitely delay the executive branch’s implementation of KanCare 2.0.
“We believe that the state has not demonstrated the ability to handle the most basic of tasks required to run the program,” he said. “The state should be required to show competency in these tasks before it is allowed to make drastic changes.”
Lack of evidence KanCare has enhanced care of elder adults in Kansas calls for a greater level of engagement by the Legislature, said Mitzi McFatrich, executive director of Kansas Advocates for Better Care. She said KanCare was serving 2,700 fewer older Kansans than before adoption of the privatized system. The shift occurred when that sector of the Kansas population is increasing.
“There is a steady decline in both the number of older adults being served at home and in nursing homes,” she said. “It is unclear why older adults served is falling. Perhaps the eligibility backlog, inappropriate denial of services or other systematic problems are keeping critical services beyond the reach of older adults.”
Sheldon Weisgrau, director of the Health Reform Resource Project, said the oversight panel should take note of signals the Trump administration would be willing to grant states waivers to standard Medicaid policy. For example, he said, the federal government could embrace time limits on program eligibility, work requirements and increased cost sharing never previously permitted.
“These types of proposals will be viewed by some as a welcome expansion of state flexibility and by others as a dangerous erosion of beneficiary protections,” Weisgrau said. “Both sides, however, should be able to agree that the public deserves a full and open discussion and analysis of any proposed changes to KanCare.”