Advocates and beneficiaries of Kansas’ Medicaid program are pushing for more oversight and questioning a new work requirement as Kansas officials submit the program for approval by the federal government for another five years.

The Kansas Department of Health and Environment and the Kansas Department for Aging and Disability Services have been taking public comment on “KanCare 2.0,” which renews and tweaks the state’s embattled private Medicaid program, KanCare.

KDADS Secretary Tim Keck said the departments submitted an application last month to the Centers for Medicare and Medicaid Services for a renewed waiver to run the program privately through managed care organizations. Keck said that once the state receives public comments, officials will write responses and send them to CMS for approval of the program.

At issue for beneficiaries and caretakers is whether KanCare 2.0 steps up oversight after they lodged complaints about limited communication from state officials and lackluster provider networks that leave them with few or no choices for their care. CMS criticized the program earlier this year for limited oversight, initially denying it a one-year extension. Beneficiaries and advocates have also questioned new mandatory work requirements that could be imposed on 12,000 of the state’s 440,000 beneficiaries if the program is approved. The state contends the work requirement will help move people out of poverty, off Medicaid coverage and into the workforce.

“Ultimately our goal — we do feel that it is a path to independence,” said Jon Hamdorf, the state’s new interim Medicaid director.

Hamdorf’s predecessor, Mike Randol, left last month.

Hamdorf said the state is taking note of feedback from consumers on the new work requirement.

Sheldon Weisgrau, director of the Health Reform Resource Project, said he thought providing more supports and training to find beneficiaries work would be helpful, but he opposed mandatory work requirements.

“I think the effect of it will be that it will become a barrier to coverage for a lot of people,” he said.

The state’s proposal would require able-bodied adult caretakers with children older than 6 to work, volunteer or get job training in order to receive KanCare services. After 36 months receiving KanCare and working, they would no longer be eligible for KanCare services.

Weisgrau said he thought those time limits would make it difficult for people who fall in and out of poverty to receive care, and they might struggle to get health coverage if they make too much money to qualify for Medicaid but not enough to buy insurance.

“The types of jobs that we’re probably talking about, probably low-wage jobs, are not going to be putting these people into any type of position to buy insurance,” Weisgrau said.

Sonja Willms, a disabled KanCare recipient and double organ transplant survivor, said KanCare beneficiaries who want to work may be afraid of losing their health coverage. Adults who would be subject to the work requirement qualify with an income below the federal poverty level.

“So many people are on this teetering edge of falling through the cracks,” Willms said.

CMS hasn’t previously approved work requirements for Medicaid programs, but administrator Seema Verma said in a speech earlier this month the department would approve them.

“These are individuals who are physically capable of being actively engaged in their communities, whether it be through working, volunteering, going to school or obtaining job training,” Verma said. “Let me be clear to everyone in this room, we will approve proposals that promote community engagement activities.”

Beneficiaries and caretakers are also looking to KanCare 2.0 with the hope that it will fix some of the issues they have lodged against the current program.

Kathy Keck, of Wakarusa, cares for several children who receive KanCare services and had to leave her job at KDADS because it was difficult to find nursing care for her disabled children. She said the nursing agency her family works with often struggles to recruit staff.

“It seems like when we do get nurses, they don’t stay very long before they get a better-offering job and leave,” Keck said. “The pay, the benefits, all of that seem to affect them for hiring nurses.”

She said she didn’t think the initial KanCare program included enough oversight of the managed care organizations providing coverage to ensure there were enough care and medical providers to serve families. CMS also cited the program for its inadequate networks and limited oversight.

Keck said she was optimistic the problem would improve with KanCare 2.0.

“I hope they take some of the feedback from tonight and look at what could some of those performance measures be to help,” Keck said.

Suzy Springer, of Topeka, said she has struggled to reach officials when she has questions about paperwork or coverage for her mother, who is in a nursing home. Springer said she attended a public comment session Thursday to get answers but decided to speak up when officials talked about improving efficiency in KanCare 2.0.

“They’re not very efficient if they don’t have the capability of even communicating with people who have questions,” Springer said.

Hamdorf said the program would have a significant level of state oversight. In its reapplication to the federal government, the state promises improved oversight of managed care organizations.

“The oversight of the KanCare committee is the highest concern of leadership,” Hamdorf said.