"SRS releases spending cut list: one page document outlines plan for $43 million budget reduction"

By Dave Ranney
KHI News Service
Aug. 26, 2011

TOPEKA — The Kansas Department of Social and Rehabilitation Services on Friday released an outline of its plan for cutting more than $43 million from its budget.
Almost half the cuts – $19.3 million – are tied to not-yet-defined reforms to the state’s Medicaid program.
The plan also calls for eliminating almost $3.8 million in state-funded grants and contracts, though it’s unclear which ones.

Document

SRS budget reductions, FY 2012

Download .XLSX

The list of spending reductions, followed by their state and all-fund savings:
• Eliminate SGF for dues and subscriptions for SRS and state hospitals; $68,809; $110,347.
• Delay computer purchases; $426,790; $879,945.
• Delay server replacement; $150,000; $312,827.
• Salary reductions; $710,201; $1,573,862.
• Other operating reduction; $462,729; $1,017,074.
• SRS office closures; $400,000; $416,800.
• Eliminate selected contracts; $3,478,732; $3,981,952.
• Three percent cut to remaining contracts except leases; $418,099; $878,588.
• Three percent cut to contracted janitorial services; $9,143; $20,812.
• Claim federal funds on Medicaid contracts for disability and behavioral health services; $304,788; $304,788.
• Medicaid reform savings; $8,433,274; $19,341,681.
• Savings from contractual arrangements affecting in-home services from the disabled (Financial Management System); $2,378,359; $5,588,250.
• Savings from electronic timekeeping for attendant care workers; $2,196,023; $5,159,829
• Eliminate selected grants; $325,000; $325,000.
• Three percent cut to remaining grants, excluding foster care, family preservation, Early Head Start and mental health; $1,527,584; $2,092,650.


The reductions in state spending total $21,289,531; for all funds the total reduction is $41,679,405.
The plan also includes a projected $1.5 million increase in state gaming revenues, and calls for raising an additional $16,400 by charging non-SRS groups for use of the conference rooms at the SRS Learning Center in Topeka.
Earlier this year, lawmakers agreed to cut about $21.5 million from the state-funded portion of the SRS budget and more than $43 million from all funds, including federal matching dollars.
The cuts are to take effect in fiscal 2012, which began July 1, 2011.
“We’re not living in the same economy we were living in four years ago,” said Angela de Rocha, a spokeswoman for SRS. “We are trying to deal with that as responsibly as we can and still provide services to the people that it is our responsibility to serve.”
De Rocha said the salary reduction had been accomplished by consolidating some positions within the agency.
The electronic timekeeping for attendant care workers, she said, should be up and running by Nov. 1.
Earlier this week, members of the House-Senate Home and Community-Based Services Oversight Committee asked SRS for a copy of the plan.
“We know we’re making a lot of cuts,” Rep. Bob Bethell, R-Alden, said Friday. “But it’s becoming my impression that they’re not being made in a systematic way. I wanted to know what the plan was.”
After receiving the one-page plan from SRS, Bethell said he had more questions than answers. “I don’t see how they come up with $710,000 in salary cuts when everything I’ve heard and seen shows they’re spending more on central-office salaries than they were before. The other thing is that it looks to me like the big money is going to be coming out of services for the people in Kansas who happen to be less fortunate. I’m not sure that’s good for the state of Kansas.”
Sen. Laura Kelly, D-Topeka, said she was disappointed in the plan. “We need more information,” she said. “There’s not much here.”
In an email to KHI News Service, de Rocha noted that plans call for closing the SRS offices in Lyndon, Garnett, Wellington and Pratt on Sept. 2. Other planned office closings:

• Sept. 9 – Coffeyville,
• Sept. 16 – Marysville and McPherson, and
• Sept. 23 – Fort Scott.

"SRS drops grant support for two child advocacy programs"

By Dave Ranney
KHI News Service
Aug. 23, 2011

TOPEKA — As part of ongoing budget cuts, officials at the Kansas Department of Social and Rehabilitation Services have decided not to renew the agency's contracts with two child advocacy programs: Keys for Networking and the Kansas Youth Empowerment Academy.

As a result, the Kansas Youth Empowerment Academy is expected to close on Dec. 31.

“We’re fairly new, so we don’t have a lot of reserves built up,” said Julia Thomas, the program’s director. “We’ve been told we can rebid on the contract, but there are some bigger programs out there that want it. We can try, but I doubt that we’d get it.”

Launched in 2005, the academy is charged with helping young people with disabilities learn job skills, find employment and live independently.

Each of the academy’s five employees is disabled; Thomas is blind.

SRS’ contract with the academy was for $150,000 a year.

Keys for Networking’s future also is uncertain. “I don’t know what’s going to happen, but I do know that we’re not giving up,” said the program’s executive director, Jane Adams.

The program’s contract with SRS was for $288,000 a year. The contract ends Aug. 31.

Under its contract, Keys for Networking worked with hundreds of teenage children in foster care who were at risk of not graduating from high school.

“Our task was to make that (graduation) happen,” Adams said.

When SRS began the contract in 2006, less than one-fourth of the teenagers who aged out of the foster care system had high school diplomas. Last spring, she said, more than 80 percent graduated.

Keys for Networking staff developed a spread sheet that kept track of the students’ credit hours, where they were going to school and where they were living.

“For some of these kids, it wasn’t unusual for them to move two or three times a semester,” Adams said. “When that would happen, we’d get everybody on the phone and find out what needed to happen to make sure that kid’s credit hours followed him from one school to the next."

Keys for Networking has 10 full- and part-time employees.

In an email to KHI News Service, SRS spokeswoman Angela De Rocha wrote that SRS workers plan to take over the Keys for Networking role. She also noted that the state’s four foster care contractors are responsible for meeting the educational needs of the children in state custody.

Kansas privatized most of its foster care system in 1997. Currently, SRS contracts with KVC Health Systems, St. Francis Community Services, TFI Family Services and United Methodist Youthville.

Keys for Networking’s role, De Rocha wrote, was “greatly reduced” earlier this year when legislators passed Senate Bill 23, which in part stipulates that children aging out of foster care will be allowed to graduate if they’ve accumulated a minimum of 21 credits hours.

Prior to the new law, foster children, depending on where they lived, may have been required to have as many as 32 credit hours to graduate. In Kansas, graduation requirements vary from school district to school district.

Adams, who helped write Senate Bill 23, said the new law is sure to give teenagers a clearer picture of what they need to graduate, but it does little to help them or their advocates keep track of their records as they move from one foster home to another.

Children in foster care are allowed to ask a judge to release them from state custody once they are 17; they’re allowed to remain in the system until they are 21.

Keys for Networking also has a separate contract with SRS to help mentally ill and emotionally disturbed children who are not in foster care but who may have been suspended or expelled from school due to aberrant behaviors.

That $150,000 contract was recently extended until the end of September.

“We’ve been told that we’ll be able to bid on it,” Adams said. “It was supposed to end June 30, but it’s been extended to the end of September. The RFP (request for proposal) isn’t out for it yet.”

"SRS to release plan for cutting budget" Legislative committee asks for information

By Dave Ranney
KHI News Service
Aug. 23, 2011

TOPEKA — Later this week, the Kansas Department of Social and Rehabilitation Services will release its plan for cutting more than $43 million from its budget.

“You will have it in the next few days,” SRS Deputy Secretary Pedro Moreno said Tuesday, addressing members of the Legislature's Joint Home and Community Based Services Oversight Committee.

The plan will be forwarded to Legislative Research Department for dissemination to legislators, after which it will be made public.

Moreno offered to share the plan after Rep. Bob Bethell, R-Alden, said he’d been hearing many of his constituents complain that SRS had been less than forthcoming with information on how the cuts would be implemented.

“It’s unfortunate,” he said, “that we hear a lot about what’s about to happen, but we’ve yet to see an actual plan.”

Bethell said he wanted the plan in writing and “exact” in detail.

Earlier this year, lawmakers agreed to cut about $21.5 million from the state-funded portion of SRS’ budget; more than $43 million from all funds, including federal matching dollars.

The cuts take effect in fiscal 2012, which began July 1, 2011.

SRS officials in the last several weeks have announced a number of cuts, including a plan to close several of its regional and local offices and reductions in the amounts it pays contractors. But so far, agency officials have not released a total of what they've cut so far or what they might cut in the future to meet their budget goals. SRS Secretary Rob Siedlecki has said that “everything is on the table.”

Siedlecki did not attend the hearing Tuesday.

Other topics of discussion:

• Moreno said that SRS would be launching an initiative aimed at generating services for about 285 people with developmental disabilities now on the department’s waiting list.

Earlier this year, lawmakers agreed to fund the initiative: $6.6 million all funds; $2.8 million from the state general fund.

SRS, Moreno said, had decided to limit the expansion to services for people who are not receiving any.

Rep. Jerry Henry, D-Cummings, protested the decision, noting that legislators had wanted the expansion to include people currently receiving “partial services” as well as those receiving none.

“What you’re saying is that someone can be in a day program and be on the waiting list for residential services for five years, and you’re going to pass them by for someone who’s not receiving any services and has been waiting for two years?” he said. “That’s not what we voted on.”

Moreno said SRS would expand the initiative to include both groups, if the committee said to do so.

• Sen. Laura Kelly, D-Topeka, asked Moreno to explain why SRS had decided to eliminate funding for a Web-based training program for people who work with the developmentally disabled and why the program's operators had been given only a few days’ notice.

“You told them on July 29, and you turned the system off on Aug. 1,” Kelly said.

Moreno, who was accompanied by 15 members of SRS’ central office staff, said he wasn’t sure how the decision had been made. He said he would provide Kelly with a “very detailed explanation” by the end of the day.

“You have so many staff here and nobody knows?” Kelly said.

Moreno replied: “I’m sorry, but we don’t have that explanation for you.”

If the information was provided later to Kelly, it wasn't made public during the hearing, which ended about 4:30 p.m.

• The committee’s chairwoman, Sen. Carolyn McGinn, R-Sedgwick, said that she had heard several service providers complain that SRS had been slow in renewing their contracts and that the process for renewing the contracts was unclear.

Moreno confirmed that many of the department’s contracts with providers had been extended because negotiations were more complex than expected.

“What I know is that extensions were granted by mutual agreement in order to allow for a proper time to negotiate,” he said. “So I don’t think anybody complained about extensions.”

McGinn questioned Moreno’s logic.

“Well, you wouldn’t (complain) if that was your only choice, right?” she said. “Your choice would be ‘We’re not going to do this’ or ‘We’ll take an extension.’”

• Kelly asked SRS officials to comment on recent reports that the U.S. Department of Health and Human Services is close to citing Kansas for not doing enough to protect the rights of disabled people and that the U.S. Department of Justice is considering filing a lawsuit against the state.

Dave Davies, an SRS attorney, declined to speculate what either federal agency might or might do.

“At this point, we’ve not received a letter from HHS,” he said.

Several committee members asked Moreno and Anna Pilato, SRS deputy secretary for strategic development and faith-based and community initiatives, to discuss the department’s plan for reaching out to faith-based service providers.

Pilato said the department’s intent is to enhance services by making sure that faith-based groups are aware of the state’s needs and are asked to play a role in meeting those needs.

Pilato said she was building a list of services available in communities across the state.

“I want this to become a statewide partnership,” she said.

The list, she said, will enhance SRS’ ability to help those in need, including those who are victims of natural disasters or human trafficking.

Committee members seemed unimpressed.

Sen. Kelly Kultala, D- Kansas City, told Pilato that the Kansas Attorney General’s Office has launched a task force on human trafficking.

Sen. Dwayne Umbarger, R-Thayer, said the state Adjutant General’s Department oversees the state’s response to natural disasters.

The committee is scheduled to meet again on Oct. 11 and 12.

"DD council director removed from office"

By Dave Ranney
KHI News Service
Aug. 23, 2011

TOPEKA — Kansas Council on Developmental Disabilities Executive Director Jane Rhys has been placed on administrative leave.

Rhys had held the position for 18 years.

Contacted by KHI News Service on Monday, she declined comment. She was placed on administrative leave on Friday.

Kathleen Brennon, a member of the council’s governing board of directors, also declined comment.

The council’s governing board has the authority to hire and fire its executive director.

The council, which is federally funded, is charged with advocating for home and community based services for people with developmental disabilities.

Earlier this year, Rhys testified in favor of a bill that called for closing Kansas Neurological institute, selling the buildings on the state hospital’s campus, and using the proceeds to fund openings in community-based programs.

KNI is one of the state’s two hospitals for people with severe disabilities. The Governor's Office endorsed the idea of closing KNI, but the proposal faced stiff opposition in the Legislature last session particularly from Topeka lawmakers. The hospital is a major Topeka employer.

Rhys also has been outspoken in her opposition to the Kansas Department of Social and Rehabilitation Service’s use waiting lists to control spending on community-based services.

But it wasn't immediately clear if her positions on these issues had anything to do with her being put on leave.

“This is very upsetting,” said Barbara Bishop, executive director at The Arc of Douglas County, a Lawrence-based advocacy group.

“The DD council has been very supporting of the self-advocacy movement and we want to see that continue,” Bishop said, referring to efforts to allow and assist people with disabilities to advocate for themselves. “But we don’t know what’s going on. Nobody knows what’s going on.”

Kerrie Bacon, a member of the Kansas Commission on Disability Concerns, has been named the council's acting executive director.

In January, Gov. Sam Brownback proposed moving the Commission on Disability Concerns to his office from the Department of Commerce.

The commission, also federally funded, is charged with promoting barrier-free communities for people with disabilities and recommending legislation to help achieve those goals.

The commission’s four-person staff moved to the governor’s office July 1.

"Lack of services for disabled could trigger federal lawsuit"

U.S. attorney for Kansas issues warning at disability conference

0 | Government, SRS, Legislature, Health Care Delivery, Medicaid-CHIP

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By Dave Ranney
KHI News Service
Aug. 11, 2011

U.S. Attorney for Kansas Barry Grissom.

A federal official on Thursday said that a report currently being finalized will show that Kansas isn’t fully complying with the law that protects the rights of disabled people.

Barry Grissom, the U.S. Attorney for Kansas, said how the state responds to the soon-to-be issued report from the U.S. Department of Health and Human Services (HHS) will determine whether it can avoid a federal lawsuit.

Grissom said the best outcome would be for federal and state officials to agree on a plan for bringing the state into full compliance with the law.

“We always want to work with our partners at the state level,” he said in an interview with the KHI News Service. “That always is the best way, the most cost effective way. And I think you get the best results when you do it that way.”

But if that doesn’t happen, he said, “The Department of Justice would have to review the findings of HHS and make a determination as to whether there’s going to be a lawsuit.”

Grissom was the luncheon speaker at the 12th Annual Kansas Disability Caucus at the Capitol Plaza Hotel and Convention Center in Topeka.

Grissom assured the audience of 200-plus people that both his office and the U.S. Department of Justice are “committed to aggressive enforcement of the (U.S.) Supreme Court’s decision in Olmstead,” a reference to a landmark case in which the court ruled that states are obliged to provide services for disabled persons in settings that are most appropriate to their needs.

“In that decision,” he said. “The court ruled that people with disabilities have a right to live in communities and not be locked away in an institution.”

Grissom said he was aware that more than 5,000 people with developmental and physical disabilities are on waiting lists administered by the Kansas Department of Social and Rehabilitation Services.

Advocates for the disabled have long argued that the waiting lists constitute a violation of the Olmstead ruling.

Many in the audience encouraged Grissom to announce his office’s intent to file a lawsuit, challenging the waiting lists. He declined to do so.

“There are a lot of expectations in this room right now,” he said. “I cannot make any promises to you today. I can’t tell you everything I know today. But I will tell you this: As long as I have the great honor and great privilege to be serving as the U.S. Attorney for the District of Kansas, the disability rights community has no bigger friend.”

Document

SRS letter to KACIL

Download .PDF

Stephanie Stanford, a coordinator with the Kansas Association of Centers for Independent Living, was seated next to Grissom.

“I don’t have to watch what I say,” Stanford said, noting that Kansas legislators and policymakers have not supported efforts to create a state plan for complying with the Olmstead ruling and eliminating the waiting lists.

Stanford said that in response to an open records request, KACIL had received a letter from SRS (PDF), indicating that it did not have a plan for complying with the Olmstead ruling and that such a plan was not mandatory.

“I didn’t go to law school, and I’m not an attorney,” she said, “But if that’s not a smoking gun, I don’t know what is.”

Stanford later provided KHI News Service with a copy of the June 23 letter.

Earlier, Grissom said that while states are not required to have Olmstead plans, those that do not will a hard time defending their policies – waiting lists, for example — in court.

Grissom said he was aware that Kansas does not have an Olmstead plan. “Before a state begins to defend itself — that should be in place,” he said. “Having an Olmstead plan is the first step.”

Grissom shared that his office and HHS have investigated several complaints of Olmstead violations in Kansas.

Shari Coatney, executive director with the Southeast Kansas Independent Living Resource Center in Parsons, said her agency has filed more than 200 complaints with the U.S. Attorney’s office.

“The issues that were discussed here today aren’t new,” Coatney said. “What is new is that now it looks like the federal government will be providing some motivation for the state to do something.”

—Jim McLean contributed to this story.

Safety Net Dental Clinics

This excerpt is from Oral Health Kansas.  Learn more at www.oralhealthkansas.org:

TRANSITIONING YOUR DENTAL CARE AS AN ADULT
Many young people transitioning to adult services for people with disabilities remain with their family’s dentist.  Other young people who are enrolled in Medicaid for health care benefits will find that they no longer have dental benefits.  This means that Medicaid only pays for emergency dental care when the person has mouth pain, injury, infection, or a loose tooth.  Dental services that are covered by Medicaid include x-ray, examination, and tooth extraction.

Some community dentists in private practice accept Medicaid or work out payment plans. These public health dental clinics accept Medicaid or charge fees for services based on the patient’s ability to pay.

Kansas Safety Net Dental Clinics: 

Atwood Rawlins County Dental Clinic 785.626.8290 Columbus Community Health Clinic of Southeast Kansas 866.396.6788 Dodge City United Methodist Mexican American Ministries Dental Clinic-Dodge City 620.227.9797 Emporia Flint Hills Community Center 620.342.4864 Garden City United Methodist Mexican American Health Ministry 602.272.0570 Hays First Care Clinic Inc 785.623.6210 Hutchinson Prairie Star 620.663.8484 Iola Community Health Clinic of Southeast Kansas 866.396.6788 Junction City Konza Prairie 785.238.4711 Kansas City, KS Southwest Boulevard Swope Health 913.722.3100 913.922.3111 Lawrence Douglas County Dental Clinic 785.312.7770 Manhattan Konza Prairie 785.320.7134 Olathe Health Partnership 913.648.2266 Pittsburg Community Health Clinic of Southeast Kansas 866.396.6788 Salina Salina Family Care 785.826.9017 Topeka Marian Clinic 785.233.2800 Wamego Community Health Ministries 785.456.7872 Wichita E.C. Tyree GraceMed Hunter Health Clinic 316.681.2545 316.866.2000 316.262.3611

"Final Medicaid reform public forum announced"

By KHI NEWS SERVICE
KHI News Service
Aug. 5, 2011

TOPEKA — The fourth and final public meeting on remaking Medicaid will be at 5 p.m. Aug. 17 in Overland Park (map), administration officials announced today.

Those planning to attend are asked to RSVP here.

The first forum was held in Topeka in June, the second in Wichita and third in Dodge City last month.

Since campaigning for governor, Brownback has argued that one way to better manage the state's budget would be to trim Medicaid costs.

To that end, he tasked Lt. Gov. Jeff Colyer with finding ways to cut between $200 million and $400 million from the program in time for fiscal 2013, which begins July 1, 2012. Brownback also has said he intends to improve the quality of care for Medicaid beneficiaries.

Colyer said in today's press release that he's pleased with the level of participation so far.

“Moving forward, it’s my hope in Overland Park, we can drill down into the details and receive more feedback on some of the ideas that were developed in the previous public meetings,” Colyer said.

Kansans can also submit their ideas for Medicaid reform online until Aug. 19.

"SRS drops support for training program"

By Dave Ranney
KHI News Service
Aug. 2, 2011

TOPEKA — The Kansas Department of Social and Rehabilitation Services has dropped its participation in a Web-based training program for those who work with the developmentally disabled.

The decision, effective Wednesday, is expected to save the department about $200,000.

“We’re looking to see if there’s a way to maybe form a coalition to purchase the service without SRS’ support,” said Kathy Olson, who administers the College of Direct Support program on behalf of the University of Kansas Life Span Institute.

Though based in Lawrence, the institute occupies two buildings on the campus of Parsons State Hospital, one of two state-run institutions for people with severe developmental disabilities. The other state facility is Kansas Neurological Institute in Topeka.

Olson, whose office is in Parsons, said she first learned of SRS’ decision on Friday afternoon.

SRS officials did not respond to a KHI News Service email Monday, seeking comment on the decision.

Agency officials over the past several weeks has taken or announced several steps intended to reduce SRS spending. The Legislature this past session ordered SRS to make about $21.5 million in state spending cuts. Among other things, SRS officials have announced they will close a number of local or regional offices.

Developed by researchers at the University of Minnesota, the College of Direct Support training program offers a web-based curriculum for people such as family members, teachers, attendants and day program employees who care for people with developmental disabilities.

“There are well over 150 lessons,” included in the training package, Olson said. “It’s multi-media, it’s updated, it’s all evidence based, it’s accessible 24 hours a day, seven days a week. It provides training toward a national standard for excellence.”

In Kansas, she said, 138 service providers – more than one-third of all providers, large and small – were using the curriculum in their staff training.

“We’ve been very satisfied with it,” said Carolee Miner, executive director at OCCK, a Salina-based program for people with developmental disabilities.

The program, however, isn't free. In Kansas, much of the program's costs were covered by SRS’ $200,000 contract with the Life Span Institute.

Olson served as the program's liaison to the College of Direct Support.

College of Direct Support National Director Bill Tapp said 33 states subscribe to the Website. Kansas, he said, has been the first state to drop out.

“At any given time in any given month there are 280,000 people taking the training,” Tapp said. “Kansas, I’d say, has been using it for four or five years.”

Tapp said he would help the KU institute search for alternate funding.

“No one called us ahead of time and said ‘What can we do?” he said. “The first we found out about this was Friday afternoon – the same time everybody else found out about it. But this isn’t about money, it’s about putting together a trained workforce to work with an at-risk population.

“If you’re going to have a trained workforce, there has to be training,” Tapp said. “And if you’re going to have training, you have to have a curriculum. That’s what we do.”

"Dental association to urge members to accept Medicaid patients"

By Phil Cauthon
KHI News Service
Aug. 1, 2011

"TOPEKA — The Kansas Dental Association announced today an initiative to get 140 more dentists signed up as Medicaid providers and start accepting patients.

In Kansas, children 18 and under are eligible for dental coverage under Medicaid. However, only 350 of the state's 1,425 dentists treated at least one Medicaid patient last year, according to the KDA.

About 129,000 children received oral care through the Medicaid program between July 2010 and June 2011 — an average of more than one Medicaid patient per day for the dentists who accept them.

KDA director Kevin Robertson said there's a certain "Medicaid lore" among dentists that keeps most of them from accepting patients. He hopes that the Medicaid 140 Initiative — which will consist of events around the state and other communications to dentists — will help convince some dentists to at least give it a try.

"We think many dentists will listen, though 140 is an ambitious number," Robertson said.

"We're encouraging dentists to just give it a shot. Do a couple Medicaid patients, send in your claim forms, get paid and then take on a few more — just ease into the system," he said.

"We can't rely on a few dentists to do the lion's share of the Medicaid work, especially at a time when there's more and more Medicaid patients being put into the system," Robertson said.

Incentives

KDA has limited tools at its disposal to encourage dentists to accept Medicaid patients.

Currently in Kansas, Medicaid reimburses at 56 percent of a dentist's usual fee. Robertson said dentist offices average about 60 percent overhead costs, so some dentists actually lose money when seeing Medicaid patients.

Robertson said the KDA continues to work with Gov. Sam Brownback's office and legislators to raise the reimbursement rate, but he said that's a tough sell amid Medicaid budget concerns.

The same goes for extending oral coverage to all Medicaid-eligible adults. KDA asked the legislature to do so this year as part of its plan for addressing the state's dentist shortage, but then removed the Medicaid provision because legislators labeled it "dead on arrival," Robertson said. He said the health reform law will increase the share that the federal government pays in 2013, so the KDA plans to re-introduce the proposal then.

Robertson said other states, such as Oklahoma, have implemented tax credits for dentists who accept Medicaid, but Kansas has not pursued that route yet.

'Put up or shut up'

Dr. Susan Hall has been a dentist in Lawrence for 16 years and in Arizona for nine years before that. Hall, who has accepted Medicaid patients for all 25 years, said she's not sure how many Medicaid patients she has now — she doesn't want to know who they are to avoid biasing decisions she makes about care.

That said, Hall's office staff keeps the percentage at a certain rate her practice can afford.

"The state pays such a limited amount," Hall said. "The way they budget things, they actually pay less than most insurance will, and it barely covers the cost of seeing the patient. But I feel like underprivileged children should have the same quality of care as other people. They can't help it that they can't afford the care."

She said one incentive for dentists to accept Medicaid patients is the proposed mid-level dental practitioner. The KDA opposes allowing so-called mid-level practitioners to do basic procedures currently done only by dentists in Kansas.

Advocates have supported licensing mid-level practitioners in Kansas as a way to expand oral care access for Medicaid and uninsured patients.

For her part, Hall doesn't really support the mid-level practitioner concept — but she said, it would be better than some Kansans going without care at all.

"If dentists don't take on that role of being Medicaid and Medicare providers, they're going to push the state into accepting that kind of provider," Hall said, referring to mid-level dental practitioners.

"It's time to put up or shut up," she said."