Uncertainty looms over health care policy as lawmakers prepare for session

By Jonathan Shorman, January 05, 2017

Kansas enters 2017 amid national uncertainty over health care policy and worries at home about the state’s Medicaid program.

The election of Republican Donald Trump, along with a GOP-controlled Congress, signals trouble ahead for the Affordable Care Act, and with it the prospects for Medicaid expansion in Kansas.

At the same time, processing problems have haunted KanCare, the state’s Medicaid program, over the past year, and lawmakers continue to fear a backlog that officials spent months trying to wind down will grow again.

Still, Gov. Sam Brownback’s administration is bullish on the year ahead.

Lt. Gov. Jeff Colyer tweeted in mid-December that Kansas had renewed its KanCare contracts for the year ahead and that Medicaid expansion was dead. Time will bring clarity from D.C., he said, adding that a new request for proposal on KanCare will come in late 2017.

“(Donald Trump) has proposed block granting Medicaid to the states. This is a great opportunity for Kansas and KanCare,” Colyer said.

Trump campaigned on repealing and replacing the Affordable Care Act, the 2010 law championed by President Barack Obama. Some Republicans support turning Medicaid into a block grant program.

“States will no longer be shackled by federally determined program requirements and enrollment criteria. Instead, they will have the freedom and flexibility to tailor a Medicaid program that fits the needs of their unique populations,” House Speaker Paul Ryan’s Medicaid plan says.

The Centers for Budget and Policy Priorities, a left-leaning think tank, said block grants would institute deep cuts to funding for state Medicaid programs and threaten benefits for low-income individuals. Sean Gatewood, with the KanCare Advocates Network, said that wouldn’t be a good idea given KanCare’s issues.

“I can’t imagine what it would be like if it was sort of a complete blank check, what that would mean for people with disabilities across the entire state,” Gatewood said.

Supporters of Medicaid expansion say the potential for block grants lend greater urgency to their cause. Democratic lawmakers argue expansion will bring in additional federal money into the state, thereby making it more likely Kansas would receive more cash under a block grant system.

“A lot of us are concerned that if we don’t expand Medicaid now — even though that 100 percent (federal) match is down to 95 now — that should feds go to the block grant, then we’ll lose out,” Sen. Laura Kelly, D-Topeka, said.

After tax cuts, the creation of KanCare has arguably been Brownback’s biggest policy achievement. In an effort spearheaded by Colyer, Kansas privatized its Medicaid program in Brownback’s first term, handing operations to managed care organizations.

KanCare provides services to hundreds of thousands of Kansans through plans offered by the managed care organizations. Currently, Amerigroup, Sunflower and UnitedHealthcare offer plans.

After implementing a new electronic eligibility system in 2015, Kansas developed a backlog in processing Medicaid applications. For much of the past year, the state has worked to bring the backlog under control.

At its peak, the backlog included more than 15,000 applications. The state spent more than $2 million on anti-backlog efforts.

State auditors found that Kansas wasn’t in compliance with federal law on eligibility determinations. Federal officials indicated to auditors, however, that no action will be taken against Kansas once the backlog is resolved.

But lawmakers fear the underlying problems that led to slow processing haven’t been fixed.

“They don’t have the backlog taken care of,” said Rep. Dan Hawkins, R-Wichita.

Hawkins chairs the House Health Committee. He said he would like an independent study to look for where the processing bottlenecks are occurring.

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