Facing skeptical lawmakers, state officials strike at critical KanCare report

By Jonathan Shorman, January 23, 2017

The agency that oversees KanCare on Monday called a scathing federal report against the Medicaid program incomplete and criticized the quality of its analysis under intense questioning by lawmakers.

Susan Mosier, secretary of the Kansas Department of Health and Environment, defended the program and its employees in a tense appearance before the Senate Public Health and Welfare Committee. The agency doesn’t anticipate problems renewing KanCare under President Donald Trump’s administration, she said.

The secretary expressed no qualms with two reform measures lawmakers are considering. They include moving the KanCare inspector general’s position into the attorney general’s office and making the KanCare ombudsman independent on KDHE.

Lawmakers summoned Mosier to the Statehouse after the disclosure last week that the federal Centers for Medicare and Medicaid Services had denied Kansas a one-year extension of KanCare, from the end of 2017 to the end of 2018. CMS also produced a harsh report of the program, based on an October visit and documentation provided by the state.

The report found the program is “substantively out of compliance” with U.S. law and regulations. Kansas must submit a corrective action plan by Feb. 17.

Mosier said health outcomes under KanCare have improved since before the implementation of the program in 2013. Those outcomes are a key metric that demonstrates the program has oversight and is working well, she said.

“I do believe the quality of the CMS analysis was extremely poor. I don’t fault the people who wrote the report because I think it was rushed out and I think they didn’t have time to evaluate the over 2,500 documents and 40,000 pages,” Mosier said.

After the disclosure of the CMS report and its response to the extension request, Gov. Sam Brownback’s office sought to paint the move as a parting shot from President Barack Obama’s administration. Lt. Gov. Jeff Colyer called CMS’ actions “politically motivated.”

Mosier didn’t repeat the charged language from Colyer, but did indicate she believes the state’s situation will change under President Donald Trump.

In its communications to Kansas, CMS indicates financial sanctions are possible against the program. Kansas spends about $100 million in federal funding a year for administrative functions related to Medicaid.

KDHE officials were unable to provide lawmakers with the potential size or effect of financial sanctions, but told lawmakers they could provide additional information later. They argued financial sanctions will be unlikely after they provide their rebuttal to the federal report to the Trump administration.

“As we provide this analysis to the new administration, I do not see that we will be encountering any change in our federal financial participation,” Mosier said.

The committee’s ranking Democrat, Sen. Laura Kelly of Topeka, said she was disappointed but not surprised by KDHE’s reaction to CMS.

“If CMS were politicizing this, we probably wouldn’t have a KanCare system here in Kansas,” Kelly said. “I’ve been trying, others have been trying, since even before the inception in 2012 to work with CMS, to have them either disallow the KanCare program altogether or at least bring a heavier hammer on it and they have chosen not to do that for a very long time.”

The committee chairwoman, Sen. Vicki Schmidt, R-Topeka, said lawmakers need to be kept aware of how Kansas responds to CMS in February. Lawmakers need more information about what data state officials believe federal officials didn’t consider, she said.

“I think all of us have heard from advocacy groups and certainly individual patients and beneficiaries about issues in KanCare and it’s very important they be looked into,” Schmidt said.

Legislators are pursuing a bill to move the dormant KanCare inspector general position into the attorney general’s. The position has gone unfilled since 2014.

Another bill would move the KanCare ombudsman out from under KDHE. The aim is to ensure true independence for the ombudsman.

Mosier said the agency supports moving the inspector general to the attorney general’s office and wouldn’t oppose moving the ombudsman. Schmidt predicted swift action on both items.

Sean Gatewood, with KanCare Advocates Network, called the Mosier’s openness to moving the inspector general and ombudsman a positive development. He disagreed with Mosier’s criticism of the CMS report.

“I think there are these issues and frankly I didn’t hear the administration pushing back hard on what the actual facts were, that there are those issues,” Gatewood said.


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