By Tim Carpenter, August 25, 2016
JIll Bronaugh and her son Nocholas Bronaugh.
(Photo by Thad Allton/ Topeka Capital-Journal)
If given an opportunity to share with Gov. Sam Brownback her personal opinion about the state’s privatized Medicaid system, Topeka resident Jill Bronaugh would speak of the struggle to care for her son with cerebral palsy.
Bronaugh’s 9-year-old boy, Nicholas, cannot walk unaided. He qualifies for skilled nursing assistance that allows him to live outside hospitals and institutions. A nurse accompanies him to school and cares for him while his parents work to provide for the family of five.
Problems with Medicaid services for Nicholas emerged in the past, Bronaugh said, but “nothing could have prepared us for the nightmare that awaited with KanCare.” That’s the name of the Medicaid system adopted by Brownback in 2013 and operated through contracts with the Amerigroup, United Health Care and Sunflower insurance companies.
Bronaugh said her son’s nursing-care hours were cut 40 percent at about the same time she raised questions about Sunflower’s noncompliance with contractual obligations. She shared documents showing Sunflower staff claimed she lied about her son’s disability to secure help he wasn’t eligible to receive. Bronaugh said the false allegations were an attempt to silence her and get her to drop an appeal of the nursing time.
“I was harassed and bullied in my own home by Sunflower,” she said. “I truly feel like the reduction in services was retaliation for my strong advocacy for my son.”
Her feedback would have been the type likely to surface this week during a five-city listening tour that was to have provided Brownback officials insight into the governor’s 4 percent budget cut to some Medicaid providers on July 1. The $38 million was reallocated in an attempt to balance the state’s budget.
Forums in Topeka, Overland Park, Wichita, Pittsburg and Dodge City were canceled to limit public disclosure of how Kansans viewed KanCare. The $3 billion system serves about 420,000 disabled, poor and elderly Kansas residents.
Officials of the Kansas Department for Aging and Disability Services, as well as the Kansas Department of Health and Environment, acknowledged growing pains with KanCare, but told state lawmakers the collaboration with private industry ought to be viewed as a success. Bipartisan criticism of the Medicaid cut did lead Brownback to recommend restoration of funding through adoption of a special tax on hospitals.
KanCare is a plan spearheaded by Brownback and Lt. Gov. Jeff Colyer, who promised the overhaul would produce better health outcomes for Medicaid recipients and save the state $1 billion over five years without reducing eligibility, benefits or provider rates.
Not all KanCare feedback during the planned listening tour would have been negative.
Wichita resident Shelitha Walker, who has a disabled son, said she was pleased with medical and transportation services provided for the boy through Sunflower.
“It was a burden lifted,” Walker said. “I feel they go above and beyond to meet the needs of my son, and his health is in their best interest.”
However, decisions by state agencies with jurisdiction over Medicaid and the companies holding KanCare contracts remain controversial.
Marilyn Kubler, mother of a 37-year-old with Down syndrome, said Jennifer Kubler moved four years ago to her own apartment, and with support, had done reasonably well. She holds a job and enjoys a more independent lifestyle, her mother said, but rules proposed by KDADS to limit reimbursements to providers making face-to-face contact with clients could force the woman to live in a group home.
“I believe this policy was put in place only to save money for the state and not for the well-being of the individual,” Marilyn Kubler said.
Roxanne Hidaka, co-owner of Case Management Services in Overland Park, said she opposed handing Medicaid to outside companies and bristled at the governor’s refusal to embrace expansion of Medicaid eligibility under the Affordable Care Act. She said Kansans would benefit from federal funding guaranteed through expansion.
“Where is the leadership in Topeka that actually cares about the individuals with needs?” Hidaka said. “Had we expanded KanCare a few years ago, we could have saved some lives and helped more people.”
She also complained the managed-care companies hired by the state conducted need assessments on individuals to determine the number of hours of in-home support necessary, but family of disabled persons were not permitted to look at the analysis.
“Why not?” Hidaka said. “There is an inherent conflict of interest with an MCO deciding how many hours an individual receives and having to consider their for-profit bottom line.”
Sky Westerlund, who represents the Kansas chapter of the National Association of Social Workers, said KanCare was “fractured and is creating crisis at the street level” across the state.
Budget cuts that trigger job losses among mental health clinicians exacerbate challenges of families struggling to find clinical assistance for children, she said. A facility might schedule an initial assessment of a child one or two months in the future, she said, but needs of that child go unaddressed and likely become worse.
It might take an individual social worker in private practice up to six months to complete the application process to become a provider of services from each of the MCOs driving KanCare, she said.
“Once a provider, though, the frustration expands,” Westerlund said. “Claims for services are denied. Every time there is a denial of a claim, these small business owners are forced to battle with the MCO just to get paid. This is a KanCare practice that threatens the willingness and capacity of these providers to continue accepting Medicaid clients.”
Sean Gatewood, who represents KanCare Advocates Network, said the Kansas Legislature needed to take a larger role in oversight of the Medicaid system and press for resolution of systematic problems. He said the Brownback administration had an obligation to resolve Medicaid application backlogs by making certain staffing was in place to handle open enrollment. The administration should produce “meaningful” outcomes data on KanCare for review by the Legislature and the public, he said.
“Move the office of inspector general to the insurance commissioner’s office and require it to be filled,” Gatewood said. “Move the ombudsman’s office to an outside organization that is qualified to inform and assist people in their legal rights.”