State floats possible Medicaid changes to skeptical audience

At public input meeting, frustration over lack of discussion of current KanCare problems

By Jonathan Shorman, May 24, 2016

People attending the KanCare Renewal Tour fill the conference room at the Ramada Inn

Groups of people work through discussion questions at Tuesday
afternoon's KanCare Renewal Tour at the Ramada Hotel and
Convention Center. (Photo by Chris Neal/Topeka Capital-Journal)

Kansas may move to pay Medicaid providers based on patient outcomes while reducing the number of providers in some areas, under potential changes to the program floated by officials.

The Kansas Department of Health and Environment, which administers KanCare — the state’s Medicaid program — put forward the possible proposals Tuesday during a public input session.

More than 200 filled a hotel ballroom to hear and discuss the proposals, but several speakers expressed anger with a lack of focus on the problems currently facing KanCare, which include thousands of unprocessed applications and long wait times for those calling a state hotline.

They also voiced exasperation that the proposals had been revealed with few details. State officials said their aim was to gather input.

The frustration led to speakers attempting to translate abstract-sounding topics — “value-based purchasing” and “provider network structures” — into flesh and blood realities.

“I came here today because I thought this was going to be a stakeholder meeting. I didn’t think it was just a providers meeting. For guys like me, who are advocates at the street level, all of this is just academic, OK?” Kevin Siek, with the Topeka Independent Living Resource Center, said.

“To consumers who are just trying to live their lives and get the help they need to maintain their independence, this is not what they’re interested in. They want to know what this consolidation is really going to be about.”

The trial balloons from KDHE come a week after Gov. Sam Brownback announced a 4 percent cut to the reimbursement rate for Medicaid providers. The cut is expected to save about $38 million during the next fiscal year.

The public input session Tuesday was an early step in the state’s efforts to obtain federal approval to continue KanCare. The program currently operates as a five-year demonstration program that Kansas wants to renew next year.

“The reason why we don’t have details for you is that it really is about getting your input before we put things pencil to paper and actually create that application (for renewal),” KDHE Secretary Susan Mosier said.

The potential changes may include moving KanCare toward a provider reimbursement model where providers are paid based on patient outcomes. How outcomes would be measured wasn’t defined.

“The main feature of outcomes-driven payment is that it ties payment or enhanced payment to specific quality or cost factors,” Mosier said.

Another potential alteration includes the use of preferred networks in areas where there are more providers than needed for network adequacy. The change could include using networks with fewer providers of a particular type while maintaining adequacy, generally in urban areas.

“This is a way to cut providers more and shrink the system,” Sean Gatewood, with KanCare Advocates Network, said.

KanCare has been under fire over the past year after transitioning to a new electronic eligibility system. Problems with the system have contributed to the development of a backlog in processing Medicaid applications. The state said last week it had reduced the backlog to about 5,500 at the end of April, down from about 18,000 in February.

In addition, Medicaid recipients have complained of long call wait times using a hotline called the KanCare Clearing House. As of last week, average wait times stood at about 14 minutes, the state said, down from an average of more than 40 minutes at one point.

Sen. Laura Kelly, D-Topeka, attended the forum Tuesday.

“I think this is a colossal waste of time,” Kelly said. “Clearly, these stakeholders came here thinking they were going to have an opportunity to discuss how KanCare is or is not working,” she said, adding they were instead presented with something totally different.

Jonathan Shorman can be reached at (785) 295-5619 or jonathan.shorman@cjonline.com.
Follow Jonathan on Twitter @jshormanCJ.

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