The general status of the community I/DD system is impacted by fundamental challenges of two types, first the chronic issues which this administration inherited, and secondly the issues relating to the conversion of the Medicaid program into a managed care model.
Tom Laing, Executive Director of InterHab, provided this testimony today to the Robert G. Bethell Joint Committee on HCBS and KanCare Oversight on these matters which are critical to the I/DD community.
Two chronic and unresolved issues: Waiting Lists and Reimbursement Rates.
The State’s waiting list for I/DD services is cruelly long, and little has been done in recent years to remedy the problem, except for the excellent advocacy of the Disability Rights Center who successfully sought the Federal government’s direction to the State to eliminate the under-served waiting list. Except for that work, and the actions of the MCOs and the Community Service network to meet those unmet needs, we as a state have done little to end the waiting list. One doesn’t have to wonder how the State would react if waiting lists became the reality for schools, hospitals or highways. Action would be swift. Instead we wonder what is it about our political climate that makes it somehow OK for Kansans with disabilities to wait for years for services that they may need today.
The State’s low reimbursement rates for I/DD service providers are likely to remain unaddressed for the 10th and 11th consecutive years. This is a slowly devastating condition, and the lack of official interest is impossible to understand. When the Developmental Disability Reform Act was passed in 1995, it contained language requiring the State’s financing plans for the community I/DD service network to include adequate and reasonable reimbursement rates. No one can honestly claim that rates which have not been addressed in a decade have been handled in a reasonable or adequate way.
Has Kan-Care made a difference?
The MCO model now managing all Medicaid programs, including the I/DD network, has brought a new dynamic into the picture, one which has artificially relieved the state of direct responsibility to manage and direct the work of the community. Beyond that questionable achievement is this: the promise of managed care was vastly overstated as a cure-all for Medicaid related challenges.
While it is true that our system has not been irreparably damaged by managed care, it is equally true that the MCOs have not provided remedies for the challenges noted above.
Therefore, it can be said that KanCare has preserved the status quo for the I/DD system, but it must also be said that the status quo they inherited was woefully insufficient, and it still is. That is not a problem that originated with the MCOs, or with you. The leadership should come first from the Administration but it has not. You need to prod this Administration into more meaningful action. Adequate funding must be made available.
Reimbursement rates are the best example of administrative inaction we have seen.
The DD Reform Act of 1995 assigned the Administration the task of proposing the financing for adequate rates. Since the passage of the Act twenty budgets have been proposed by 4 governors – and only one included new funding for rate increases.
MCOs cannot make money magically appear to remedy years of IDD under-financing. Generating resources is the work of Legislators and Governors, and it needs to start this week.
Summary:
The state of our service system is grim – service curtailments, organizations at the edge of financial dissolution, hundreds of direct service positions unfilled or in a state of constant turnover because organizations are not reimbursed enough to offer competitive wages and benefits, and thousands of Kansans in need, waiting for services. Simply stated, the active support of the Legislature is needed to establish a higher priority for community services for persons with IDD.
Resolution cannot be attained by turning to the MCOs, because this is the kind of work that is above their pay grade. This work calls for leadership by elected officials.
We appreciate the good efforts of our state agency leaders, who are working with us on all such matters, and we appreciate the hard work by all involved parties to make the current system work.
And, we appreciate the serious work that rests on the shoulders of this Legislature, and your individual acts of dedication on behalf of our State.
Recommendations:
- Please exert leadership among your colleagues to assure that IDD stakeholders, service providers and CDDOs do not experience budget cuts this week.
- Please ask your leaders to set aside time this summer for a special interim on the state of our IDD system.
- Please direct the Administration to prepare financing plans for a multi-year phase out of the waiting list. It is unfair for us to expect you to prioritize services for which you have not received reliable estimates as to the costs of those services.
