TOPEKA — Kansas welfare chief Rob Siedlecki told a legislative panel today that his agency has no plans to cut Medicaid provider rates this fiscal year. But he gave no similar assurance for the coming year.
And Dr. Robert Moser, secretary of the Kansas Department of Health and Environment, which oversees the state's Medicaid program, said he couldn't yet rule out provider cuts as a possibility for fiscal 2013, which begins July 1, 2012.
Moser and Siedlecki are members of a work group led by Lt. Gov. Jeff Colyer that for the past several months has been crafting a plan to cut the state's Medicaid costs. Officials have said they also want to improve the quality of care for Medicaid patients. Colyer, Siedlecki and others from the administration of Gov. Sam Brownback began the planning process saying they intended to cut Medicaid costs between $200 million and $400 million by fiscal 2013.
But Brownback officials more recently have been backing away from those numbers. And today Moser was questioned directly about the planned reductions by members of the Legislature's Joint Committee on Health Policy Oversight.
'Numbers don't add up'
"I'm having trouble understanding how you take $200 million to $400 million out of the program," said Sen. Laura Kelly, a Topeka Democrat. "The numbers just don't add up."
Most budget analysts say it would be difficult or impossible to reduce the program's costs by that much that quickly without cutting rates paid to doctors and other care providers or without major cuts in services to beneficiaries. Both are options that Brownback officials at various times have said they cannot or do not want to exercise.
Moser told the committee that the administration is looking at shifting more Medicaid patients into managed care programs and that the reform plan also would focus on stronger or "targeted" case management and other methods to bring down costs. But he said it would take time to achieve savings of $200 million or $400 million.
The new approaches, he said, "over the long run will get us to the savings, and that's where that $200 million or $ 400 million maybe comes from. It's not going to be easy. It's not going to happen next year. It's going to take time to develop these programs."
Moser said he could promise there wouldn't be "deep" provider cuts along the lines of a 10 percent reduction recently enacted in California and challenged in federal court. But he said he couldn't rule out the possibility of some cuts to rates.
'Not our first choice'
"Provider rate cuts are not our first choice, and Gov. Brownback has mentioned this over and over and over," Moser said. "But ... I'm going to have to just say I wouldn't take anything off the table, because it may take a combination of things. However, as a provider that's going to be my last recommendation" for achieving the unspecified savings the administration will seek for fiscal 2013.
Moser, a former family practice physician in Tribune, said he was well aware that payment cuts to doctors could drive some of them out of the Medicaid program, making it more difficult for Medicaid beneficiaries to get attention before their problems grew costlier to treat.
"Medicaid reform has never been focused on provider cuts," he said.
Also, in response to questions from legislators, the Cabinet members told the committee members that the administration is in the process of developing a contract that would expand managed care in the Medicaid program.
They said they couldn't share details of that proposal because it was still being drafted.
Possible med school expansion
In other action:
The committee heard an update from Dr. Barbara Atkinson, vice chancellor at the University of Kansas Medical Center. She said KU officials were in the early stages of planning for a possible new building at the medical school campus in Kansas City so that another 50 students could be trained.
"We're really thinking of how we can increase the numbers over the next five years," she said.
The medical school boosted its number of first-year students this year to 191 from 175, includingincreased enrollments at the campus in Wichita and a new one in Salina.
Committee members also heard an update from Kevin Robertson of the Kansas Dental Association. He described various efforts by the association to increase both the overall number of Kansas dentists and the number who will accept Medicaid patients. He said "14 well-placed" dentists could solve most of the problem of limited access to oral health care in the state's rural areas.
Also today, Rep. Brenda Landwehr, a Wichita Republican who serves on the oversight committee, announced she would challenge incumbent Sen. Jean Schodorf, another Wichita Republican, in next year's GOP primary.
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