By Andy Marso, January 19, 2017
Kansas legislators are seeking answers from the Brownback administration after federal officials denied a one-year extension of the state’s Medicaid program known as KanCare.
The denial letter, dated Jan. 17, outlines a series of concerns about the state’s privatization of Medicaid under three insurance companies. Federal officials cited poor coordination between the Kansas Department of Health and Environment and the Kansas Department for Aging and Disability Services and said neither state agency was doing enough to hold the three insurance companies known as managed care organizations, or MCOs, accountable to Medicaid rules.
The lack of oversight puts the health of the 425,000 Kansans enrolled in Medicaid at risk, federal officials said.
Sen. Vicki Schmidt, a Republican from Topeka who chairs the Senate Public Health and Welfare Committee, asked committee members to read the Topeka Capital-Journal’s initial report on the denial letter .
Schmidt said they should prepare questions for KDHE Secretary Susan Mosier.
“I’ll be asking the (KDHE) secretary to appear before the committee Monday to respond to this,” Schmidt said.
Rep. Dan Hawkins, a Wichita Republican who chairs the House Health and Human Services Committee, said he planned to take his concerns straight to Lt. Gov. Jeff Colyer. Gov. Sam Brownback has made Colyer, a plastic surgeon, the administration’s point person on KanCare.
Hawkins said the federal Centers for Medicare and Medicaid Services denial of the extension indicates that KDHE does not have enough control over the MCOs that administer KanCare: Amerigroup, UnitedHealthcare and Sunflower State Health Plan, a division of Centene.
He said he would press for hiring an independent KanCare inspector general based out of the Kansas Attorney General’s Office. An inspector general position within KDHE has been vacant since 2014.
“I think, from a legislative standpoint, that’s long overdue,” Hawkins said.
A spokeswoman in the governor’s office said Brownback and Colyer are in Washington, D.C., attending the presidential inauguration of Donald Trump.
In a statement from the governor’s office, administration officials cast the KanCare extension rejection as a partisan move and said the program was in no jeopardy.
Colyer called it “an ugly parting shot” from the administration of outgoing President Barack Obama, a Democrat.
“It is politically motivated pure and simple,” Colyer said in the statement, “and we expect this situation to be resolved quickly once the new administration in Washington comes into office.”
The state signed contracts with the MCOs in 2012 to take over Kansas Medicaid, which is now a $3.4 billion program.
Those contracts are set to expire at the end of this year. The state had planned to solicit new bids in 2017 but asked to extend the current contracts after Trump’s election, in anticipation of changes to Medicaid funding that may allow more flexibility.
That extension application is what CMS blocked this week.
Hawkins said it’s possible a Trump-led CMS will reverse that decision. The Brownback administration also has one month to correct the problems within KanCare and resubmit the application. Mosier, in a prepared statement, said that process is underway and she is confident it will be a success.
But Hawkins said none of that comforts him, with the end of the KanCare contracts looming and no new contracts to put up for bid yet.
“We’ve got to have this extension,” Hawkins said. “I think this (denial) was a blow. Because to give us time to really be able to produce a new KanCare RFP (request for proposal), we need this extension. I don’t want to hurry this. I want to get this right.”
Stakeholders see opportunity
Organizations that work with KanCare recipients said the extension denial provides an opportunity for the state to address their longstanding concerns.
Interhab, a Topeka-based nonprofit that represents businesses that provide long-term support services to Kansans with disabilities, released a statement calling on state officials to streamline KanCare reimbursements and increase scrutiny of the MCOs.
The rejection letter from CMS gave special attention to long-term support services, which allow Kansans with disabilities to live independently in their homes and communities rather than nursing facilities. The letter said federal investigators uncovered significant infractions of Medicaid rules for those services, including MCO changes to service plans and hours without input from the service providers or the disabled people affected.
The findings came largely from on-site reviews of the MCOs in October that substantiated complaints CMS officials heard during a listening tour of the state earlier in the year.
Tim Wood, Interhab executive director, said he wished CMS would have stepped in earlier.
“What this tells me is that perhaps long-term supports were not a good fit (for KanCare),” Wood said.
Federal officials’ concerns about the medical side of KanCare were largely confined to the number of providers the three MCOs truly have in their networks.
CMS officials said the state had done little to no vetting of the MCO provider lists and the information on network adequacy couldn’t be verified.
Melinda Miner, a dentist in Hays, said Thursday that didn't surprise her.
Miner and other dentists aired concerns about dental providers dropping out of KanCare following a 4 percent cut in reimbursements last year. She said KDHE officials assured her the dental networks remained robust, even in her rural corner of Kansas.
That didn’t match what Miner was seeing on the ground. So she got the MCO lists of dental providers. For the next two weeks, she called each of them on her lunch breaks and between patient appointments.
Some were dead, some had retired and some told her they had never signed up to be KanCare providers.
“The more phone calls I made, the more interested I got in it,” Miner said. “Each county brought so many surprises it just led me to say, OK, just one more county.”
Miner eventually compiled a map that showed dental shortages throughout the western half of the state – including more than 20 counties that don’t have a single dentist who takes KanCare .
“It wasn’t my job,” Miner said. “Somebody on the state level really needed to discover what their actual network was.”
Miner said the federal findings about the lack of network oversight brought her a sense of frustration, not validation.
“I really, really hope this wakes people up to something the providers already know,” Miner said. “Which is that the system is broken."
Andy Marso is a reporter for KCUR’s Kansas News Service, a collaboration of KCUR, Kansas Public Radio and KMUW covering health, education and politics in Kansas. You can reach him on Twitter @andymarso. Kansas News Service stories and photos may be republished at no cost with proper attribution and a link back to kcur.org.