TOPEKA (TNS) — A fight between the Republican candidates for governor over the state's privatized Medicaid program could shape what happens to the health care of more than 400,000 Kansans.

The next governor could abandon a proposed work requirement for some recipients of KanCare, which serves people who are poor, elderly or have disabilities. Or he could pursue Medicaid expansion.

Lt. Gov. Jeff Colyer, who is preparing to become governor, spearheaded the creation of KanCare in 2013. Some of his opponents say the current administration, including Colyer, has poorly run the program.

"We all know that the KanCare system we have today ... has been a failure," said Wink Hartman, a Wichita businessman seeking the Republican nomination.

Democrats have widely criticized KanCare, but the split among Republican candidates means Colyer will have to defend his role in creating the program as he manages the evolution of the next version of the program this spring. The primary election takes place in August 2018.

Colyer could become governor within weeks. Gov. Sam Brownback is expected to resign after the U.S. Senate votes to confirm him as ambassador-at-large for international religious freedom.

"He will be the incumbent, so he wants to be seen as still an outsider and a reformer. So he'll be pushing this idea of reform of the healthcare system," said Bob Beatty, a political scientist at Washburn University.

Colyer will be weakened politically if his opponents successfully argue that his signature achievement has significant problems. The battle over KanCare will test his political skills, Beatty said.

"KanCare is really important to show that he did something as lieutenant governor and also to claim that reformer mantle," Beatty said.

Colyer and the state agencies in charge of KanCare have publicized their proposal for the next version of the program, including the work requirement. The plan does not call for expanding the number of people eligible for it.

"KanCare is a model for other states, leading the country with innovative changes to traditional Medicaid," Colyer said.

In response, some of Colyer's foes in the fight for the Republican nomination for governor have called on the administration to solve problems in the current program before shaking things up with KanCare 2.0. They also challenge him over Medicaid expansion.

In the past, KanCare had a backlog of applications. Federal inspectors have previously criticized the program for poor oversight.

Mark Hutton, a former state representative and Wichita businessman, said KanCare has been poorly managed. He said that although he supports work requirements for able-bodied adults, the latest proposal doesn't solve the underlying problems in the program.

"To actually make KanCare work for Kansas, we need leadership and accountability in the management of the program — something that has been sorely lacking," Hutton said.

Hutton said he wants the state to consider expanding who is eligible for Medicaid but also introducing co-pays and a work requirement for KanCare recipients.

The federal government pays 90 percent of the expansion costs for states that extend Medicaid coverage to people at up to 133 percent of the federal poverty line.

Jim Barnett, a former state senator and physician running in the primary, said most of the people who would be eligible for Medicaid under an expanded program already work. He said Kansas should focus on its current program before examining work requirements.

"I think rather than go to 2.0 they should get an extension because there's so many problems," Barnett said, adding that the program isn't working for individuals who need specialized care.

Secretary of State Kris Kobach's campaign did not respond to requests for comment. Entrepeneur Ed O'Malley also didn't comment.

Colyer said the federal government is encouraging work requirements. The administrator of the Centers for Medicare and Medicaid Services, the federal agency that authorizes KanCare, endorsed work requirements in a speech recently.

The requirements in Kansas's proposal are modeled after work requirements Gov. Sam Brownback put into place several years ago for the state's welfare programs. Colyer said those requirements had worked well.

Pregnant women, individuals with disabilities, those in long-term care and those caring for children under six would be exempt. The proposal calls for other additional exemptions as well. About 12,000 people would ultimately be subject to the requirement to work 20 hours a week or more.

"What we're interested in is common-sense solutions for us," Colyer said.

In January, the federal government denied a temporary one-year extension of the program, saying it was "substantially out of compliance" with federal law and regulations. Inspectors said the program risked the health and safety of enrollees by not providing sufficient oversight and failing to provide beneficiaries with clear and consistent information.

A one-year extension was approved by the federal government last month after Kansas took steps to correct problems. Kansas is now asking the federal government to reauthorize the $3.4 billion program for several years.

Under KanCare, the state contracts with three managed care organizations that provide the bulk of services to enrollees.

David Jordan, director of the Alliance for a Healthy Kansas, said recent election results show health care is a top priority for voters.

Earlier this month, voters in Maine approved Medicaid expansion. Healthcare was also the most important issue for voters in the Virginia governor's race, according to exit polling.

But in Kansas, Colyer has so far been unable to show KanCare has been as successful as claimed, Jordan contended.

"It still remains to be seen whether KanCare can be properly administered," Jordan said. "I think that's why you're hearing a lot of chatter about the program."