Medicaid plan unsettling for developmentally disabled
Rhonda Holman, Wichita Eagle editorial board
"The Brownback administration’s sweeping overhaul of Medicaid into a privately run managed-care system called KanCare mustn’t sweep individuals with developmental disabilities over the edge. As it is, there is a good argument for exempting the vulnerable population from such a sea change.
A packed weekend meeting in Wichita demonstrated how unsettling the governor’s plan is proving for the developmental disability community, as Department of Aging Secretary Shawn Sullivan was questioned about why the reform was needed and how it would affect loved ones.
Sullivan argues that care coordination is justified because many who are developmentally disabled suffer from medical conditions such as diabetes and high cholesterol, and have problems with mental illness and substance abuse. He makes a good point.
But families and providers are skeptical about the administration’s claims about KanCare, which will be managed by three for-profit insurance companies beginning Jan. 1, 2013 – including that services and reimbursement rates won’t be cut, that case managers needn’t change, and that current providers will be offered a place in the new system.
If such key elements won’t change, they understandably wonder, then how can dollars be saved, how can services and outcomes be improved, and why change the system at all?
It’s a further concern that only four states include long-term care for those with developmental disabilities in a Medicaid managed-care system, and that of those four, none looks like what is being proposed in Kansas, according to Matt Fletcher, associate executive director of the Topeka-based advocacy group InterHab. Moving Medicaid to managed care “can be done without having to include long-term care services,” Fletcher said at Saturday’s meeting.
The administration also didn’t help itself by crafting the reform with little stakeholder input, and by failing to get its answers straight since the plan’s November rollout. If the administration used a “very robust process” for getting input, as Mark Dugan, chief of staff for Lt. Gov. Jeff Colyer, told the crowd Saturday, it somehow was invisible to the developmental disability community.
Plus, the insurance companies interested in meeting the state’s Jan. 31 deadline for KanCare bids don’t seem to know much about serving those with developmental disabilities. And though Medicaid is costing the state too much overall, services for developmental disabilities are chronically underfunded, with a waiting list of 4,800.
Gov. Sam Brownback and Colyer are justified in trying to find a way to better coordinate care and curb Medicaid’s costs, which have grown at an average annual rate of 7.4 percent over the past decade.
But legislators need to continue to seek answers and reassurance from administration officials, including in a Senate Ways and Means Committee hearing today.
Kansas should think twice before it includes individuals with development disabilities in its managed-care experiment."
Tuesday, January 17, 2012
Monday, January 16, 2012
Dialog on managed care continues
Community
forums and legislative hearings continue as the "KanCare" proposal
for Medicaid reform becomes an increasingly visible subject. Thanks to
efforts of Kansans with DD, their families and service providers across the
state, both legislators and local media are taking note of this critical issue.
Click on the links below to learn what's been going on across the state
and at the Capitol!
Kansas Health Institute (KHI) News Service
Learn
about the Senate Public Health & Welfare Committee meeting that took place
last Thursday, January 12th.
The
Wichita Eagle
This
story was featured on the front page of the Wichita Eagle on Saturday, January
14th. Great article featuring family concerned with components of
"KanCare" proposal to include long-term services for persons with DD.
The
Wichita Eagle
Report
coverage of the community forum hosted by ACT in South Central Kansas (an
advocacy group of family members and service providers) in Wichita on Saturday,
January 14th.
KWCH
Wichita
KSN
TV Wichita
Thursday, January 12, 2012
Welcome Back Legislators
InterHab distributed the following letter to legislators today, welcoming legislators back for the 2012 session and sharing with them our concerns regarding managed care.
Welcome back to Topeka for the 2012 session!
We know it will be an especially challenging year, and we appreciate your commitment on behalf of our state to be here to address each challenge that presents itself to our fellow citizens and us.
We are committed to assist you in the coming months on any topic relating to the community network of services for persons with intellectual/developmental disabilities (I/DD). We hope you will call on us at any time, with any questions or any need for additional information.
In the coming months we will be in regular communication with you about two central issues facing the community I/DD network in Kansas: the budget, and the proposal of the Administration to fold the community I/DD waiver network into the proposed mega-Medicaid package to be managed by a national network of insurance entities. We strongly oppose the inclusion of I/DD long-term care services in the Administration’s managed care plan, and would appreciate the opportunity to brief you on the important reasons why.
Budget:
As regards the budget, we will provide more detail as soon as we are able to review the plans of the Administration for FY 2013. It is sufficient at this point to point out the two recurring and intertwined issues which have lingered now for several years. The first relates to the numbers of persons who still wait for needed services and supports, which now total more than 4,800 children and adults. The second is the continuing erosion of community reimbursement rates. Both items are in need of your attention, and should finally be among those items at or near the top of your priority lists.
We recognize that you hear many requests for funding enhancements, but we also hope you recognize (and if not, that you seek verification from your legislative staff) that our network has been hanging on for some time without meaningful support from three successive administrations. Waiting lists grow, reimbursement rates stagnate, and the system becomes weakened. These challenges will not go away.
Historically, it has been the legislative branch that has stepped forward to address community I/DD budget issues. It is our earnest hope you will consider doing so again this year.
Managed care:
The Administration’s planned inclusion of I/DD long-term care services in Medicaid managed care will have a significant impact on Kansans with I/DD and their families.
Our organization has met with the Administration for nearly a year on this matter, and however accessible and collegial they have been, they have been emphatically against our request, to exclude DD waiver services from the Administration’s Medicaid managed care proposal.
Only a few states in the nation have even attempted to include I/DD long-term care services in Medicaid managed care models. Other states that are considering inclusion are beginning the process slowly, through a phased-in approach. Nationally, the jury is still very much “out” on whether managed care has helped or harmed persons with I/DD and the systems they rely on. So-called “managed care” models are simply different strategic approaches to the management of medical insurance. The basic strategies which apply to those activities do not remotely fit our program, which is NOT a medical program.
The families with whom we work on a daily basis are certain to be in touch with you in the coming session, as will we, until or unless the Administration and/or the Legislature, takes appropriate action to remove the ID/DD waiver from the proposal to hand the Medicaid program over to the Insurance industry. Families have trusted the State/Community partnership to meet the long term needs of their sons and daughters, and we have always believed that the State would honor that partnership as well.
The proposed hand-off of that partnership to out of state insurance companies will violate that trust. We hope you will take the time to visit with us, our families and community leaders as we work to educate you on this programmatic challenge.
Thank you!
We look forward to working with you this year, and wish you the best for your work in 2012.
InterHab
Welcome back to Topeka for the 2012 session!
We know it will be an especially challenging year, and we appreciate your commitment on behalf of our state to be here to address each challenge that presents itself to our fellow citizens and us.
We are committed to assist you in the coming months on any topic relating to the community network of services for persons with intellectual/developmental disabilities (I/DD). We hope you will call on us at any time, with any questions or any need for additional information.
In the coming months we will be in regular communication with you about two central issues facing the community I/DD network in Kansas: the budget, and the proposal of the Administration to fold the community I/DD waiver network into the proposed mega-Medicaid package to be managed by a national network of insurance entities. We strongly oppose the inclusion of I/DD long-term care services in the Administration’s managed care plan, and would appreciate the opportunity to brief you on the important reasons why.
Budget:
As regards the budget, we will provide more detail as soon as we are able to review the plans of the Administration for FY 2013. It is sufficient at this point to point out the two recurring and intertwined issues which have lingered now for several years. The first relates to the numbers of persons who still wait for needed services and supports, which now total more than 4,800 children and adults. The second is the continuing erosion of community reimbursement rates. Both items are in need of your attention, and should finally be among those items at or near the top of your priority lists.
We recognize that you hear many requests for funding enhancements, but we also hope you recognize (and if not, that you seek verification from your legislative staff) that our network has been hanging on for some time without meaningful support from three successive administrations. Waiting lists grow, reimbursement rates stagnate, and the system becomes weakened. These challenges will not go away.
Historically, it has been the legislative branch that has stepped forward to address community I/DD budget issues. It is our earnest hope you will consider doing so again this year.
Managed care:
The Administration’s planned inclusion of I/DD long-term care services in Medicaid managed care will have a significant impact on Kansans with I/DD and their families.
Our organization has met with the Administration for nearly a year on this matter, and however accessible and collegial they have been, they have been emphatically against our request, to exclude DD waiver services from the Administration’s Medicaid managed care proposal.
Only a few states in the nation have even attempted to include I/DD long-term care services in Medicaid managed care models. Other states that are considering inclusion are beginning the process slowly, through a phased-in approach. Nationally, the jury is still very much “out” on whether managed care has helped or harmed persons with I/DD and the systems they rely on. So-called “managed care” models are simply different strategic approaches to the management of medical insurance. The basic strategies which apply to those activities do not remotely fit our program, which is NOT a medical program.
The families with whom we work on a daily basis are certain to be in touch with you in the coming session, as will we, until or unless the Administration and/or the Legislature, takes appropriate action to remove the ID/DD waiver from the proposal to hand the Medicaid program over to the Insurance industry. Families have trusted the State/Community partnership to meet the long term needs of their sons and daughters, and we have always believed that the State would honor that partnership as well.
The proposed hand-off of that partnership to out of state insurance companies will violate that trust. We hope you will take the time to visit with us, our families and community leaders as we work to educate you on this programmatic challenge.
Thank you!
We look forward to working with you this year, and wish you the best for your work in 2012.
InterHab
Tuesday, January 10, 2012
Legislative Calendar
SENATE:
Wednesday, January 11
Ways and Means Committee
10:30 AM RM 548-S
Overview of the Governor’s FY 2013 budget – Steve Anderson, Director of Budget
Public Health and Welfare Committee
1:30 PM RM 546-S
Managed Care RFP, ERO’s and agency reorganization – Robert Moser, Sec., KDHE
Thursday, January 12
Public Health and Welfare Committee
1:30 PM RM 546-S
ERO’s, agency reorganization – Jeff Kahrs, Sec., SRS and Shawn Sullivan, Sec., Aging
Dear Legislator
Make Managed Care Your Legislator's No. 1 Priority!
The first day of the legislative session has already passed and in a blink of an eye the first week will be over! Take this opportunity to show your concern for managed care and contact your legislators today! Below is an excerpt from e-mail message that you’ll find on the Invisible Kansans website. We encourage you to use the content that’s provided and customize it to make it your own. Act now to send this note to your legislators, Governor Brownback and even your local newspaper!
Maintaining quality services for Kansans with intellectual and developmental disabilities is very important to me. I am very concerned that the State is planning to include long-term care services for persons with developmental disabilities in its managed care plan for Kansas. Managed care models were designed to help contain costs associated with acute medical needs.
Long-term care for persons with significant intellectual or developmental disabilities is neither acute nor medical. It is a spectrum of life-long, person-focused supports that enable a person to live as independently as possible in the community of their choosing. Attempting to force DD long-term care services into a managed care model is the epitome of forcing a square peg into a round hole.
The fact that DD long-term care services are a bad fit for managed care can be seen in the vast majority of states that have chosen to specifically exclude, or 'carve out', these services for this population from their managed care plans. Only four states in the union have even attempted applying managed care to DD long-term care services. None of the DD systems in those states are comparable to the robust supports we have here in Kansas. Further, each of those states proceeded cautiously, taking years to incorporate DD long-term care into their managed care plans.
Visit the Invisible Kansans website to continue reading this message and send your e-mail today!
The first day of the legislative session has already passed and in a blink of an eye the first week will be over! Take this opportunity to show your concern for managed care and contact your legislators today! Below is an excerpt from e-mail message that you’ll find on the Invisible Kansans website. We encourage you to use the content that’s provided and customize it to make it your own. Act now to send this note to your legislators, Governor Brownback and even your local newspaper!
Maintaining quality services for Kansans with intellectual and developmental disabilities is very important to me. I am very concerned that the State is planning to include long-term care services for persons with developmental disabilities in its managed care plan for Kansas. Managed care models were designed to help contain costs associated with acute medical needs.
Long-term care for persons with significant intellectual or developmental disabilities is neither acute nor medical. It is a spectrum of life-long, person-focused supports that enable a person to live as independently as possible in the community of their choosing. Attempting to force DD long-term care services into a managed care model is the epitome of forcing a square peg into a round hole.
The fact that DD long-term care services are a bad fit for managed care can be seen in the vast majority of states that have chosen to specifically exclude, or 'carve out', these services for this population from their managed care plans. Only four states in the union have even attempted applying managed care to DD long-term care services. None of the DD systems in those states are comparable to the robust supports we have here in Kansas. Further, each of those states proceeded cautiously, taking years to incorporate DD long-term care into their managed care plans.
Visit the Invisible Kansans website to continue reading this message and send your e-mail today!
The Legislative Session Has Begun!
The 2012 session officially kicked off yesterday at 2:00pm. That means Senators and
Representatives from your home town will spend the next 4-5 months taking
hearings, proposing legislation and spending the majority of their time at the
Statehouse. Governor Sam Brownback will
deliver his “State of the State” address at 6:30pm on January 11th. The Brownback Administration has ambitious
plans for the session, including:
- School finance reform
- Tax reform
- Drawing new lines for legislative districts
Read more from Capitol Journal Online
Thursday, January 5, 2012
Managed Care Update & Overview
What is managed care?
Similar to the term casserole, “managed care” can
be defined in numerous ways and is a loose term to capture a number of
ingredients! According to the US
National Library of Medicine, “managed care” is a system of health insurance
plans that contract with care providers and medical facilities to provide care
for members at reduced costs. The
providers of care make up the insurance plan’s network.
In November, Governor Brownback unveiled a “managed
care” plan to implement sweeping changes to how Medicaid services are delivered
and reimbursed in Kansas. This plan
calls for the 'outsourcing' of all Medicaid funds in Kansas - nearly $3 billion
dollars - to out-of-state, for-profit insurance companies..
How does managed care affect individuals with DD?
With this proposal, long-term care services for
persons with intellectual and developmental disabilities -- the HCBS waiver -- will be under the
control of these insurance companies.
While these companies may have experience in managing medical services,
they have little or no knowledge or experience regarding long-term care
services for those with significant developmental disabilities. Most states across the country have excluded,
or 'carved out', long-term care services for persons with developmental
disabilities from their managed care models. Only four states have 'carved in'
DD long-term care services. None of the DD service systems in those states are
comparable to Kansas.
The Administration is racing to implement these
sweeping changes without stopping to consider the potential negative impacts to
our state's most vulnerable citizens. The impacts? A managed care system that
may separate persons with developmental disabilities from the case managers and
direct support professionals they've come to trust, and a service system that
will be controlled by private, for-profit insurance companies replacing the
direct community/State partnership that currently exists.
How can I help?
Please take a moment to ask Governor Brownback to
exclude DD long-term care services from his managed care model. Please help us preserve the half-century of
partnership and collaboration between Governors, Legislators and concerned members
of Kansas communities that built this strong, quality-focused system of
supports for Kansans with developmental disabilities.
Email the governor today through the Invisible
Kansans website:
Read More on Managed Care:
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