Despite an influx of Democrats and moderate Republicans in 2016, Kansas legislators came up just short last year of expanding the state’s Medicaid program. This year, they could consider it again along with a host of other wellness priorities, like increased funding for mental health services.

The Kansas Legislature’s 2018 session begins Monday. School finance and budget issues are expected to dominate discussion, but several health challenges and priorities face legislators eager to make improvements.

Medicaid expansion and mental health spending are priorities for some legislators concerned with access to medicine and mental health services in the state’s more remote areas. Kansas health agencies are also pushing forward on contracts to run the state’s Medicaid program and a plan to privatize a state psychiatric hospital.

Medicaid expansion

“We will continue to push to expand KanCare as long as we have the ability to bring our tax dollars back to the state,” said David Jordan, executive director for the Alliance for a Healthy Kansas.

Jordan and fellow expansion advocates argue the state should take advantage of the federal support associated with expanding KanCare to bring Kansas residents’ tax dollars back to help the state.

Several Democrats and moderate Republicans in the Kansas Legislature said they expected to see expansion return for another debate. Sen. Barbara Bollier, a Mission Hills Republican, said she anticipated the issue would come back. She said Medicaid expansion would solve issues of doctors providing uncompensated care and grant coverage to more Kansans.

“As I’ve said to the lieutenant governor, ‘If it’s not Medicaid expansion, tell me what,’” Bollier said.

House Majority Leader Don Hineman, a Dighton Republican, said he couldn’t see expansion becoming an issue during the busy upcoming session.

Mental health services

Expansion also has support from the mental health care community, members of which hope to see increased spending on mental health, too. Rick Cagan, executive director of the National Alliance on Mental Illness Kansas, said the mental health system had been neglected and would push for funds this year. He said it was critical to make sure care was available for those who need it.

“The key to keeping people in the community, getting treatment there — out of the hospital, out of the emergency room, and of course, out of jail — is having accessible and adequate community based treatment,” Cagan said.

House Speaker Ron Ryckman, an Olathe Republican, highlighted mental health treatment as an area of the budget needing attention. He said it affects other parts of the state, like schools, when people can’t access mental health services. They may languish in hospital emergency rooms or end up in prisons when they’re in crisis.

“Sometimes a little bit of investment early in some programs can be beneficial not just to the patient but to the state and the taxpayers in the long run,” Ryckman said.

State psychiatric hospitals

The state also runs to public psychiatric hospitals for those in crisis. Legislators say those facilities need attention.

Osawatomie State Hospital recently regained federal certification by the Centers for Medicare and Medicaid Services for 60 beds after nearly two years without it, making it eligible for reimbursement funds from the federal government. The state has missed out on about $1 million each month in federal funds without certification and will regain some of them through the 60 certified beds.

Now, Larned State Hospital could be at risk of losing certification, according to the Associated Press.

“We’re going to have to talk about the hospitals. They’re understaffed, underfunded and underperforming, so we’ve got work to do on them,” said Sen. Laura Kelly, a Topeka Democrat running for governor and ranking member of the Senate health committee.

CMS surveyed Larned in October and threatened to cut off its federal funds beginning this month. Kansas Department for Aging and Disability Services spokeswoman Angela de Rocha said Larned was inspected again in December and the agency had been in contact with CMS but had not yet heard back.

KDADS is also hoping to privatize care at Osawatomie, but many lawmakers are skeptical.

“I don’t believe we should be in the business of privatizing mental hospitals or prisons, period,” said Senate Minority Leader Anthony Hensley, a Topeka Democrat. “I think those are fundamental programs that government should be operating as opposed to privatizing.”

De Rocha said the project timeline depended on the Legislature.

KanCare 2.0

KDADS is also working with the Kansas Department of Health and Environment to renew the state’s privatized Medicaid program, KanCare, for another five years under a new waiver from the federal government and new contracts with managed care organizations, or private insurance companies offering Medicaid coverage.

KanCare 2.0 has drawn controversy for imposing work requirements on some beneficiaries. The department argues those will help KanCare members gain independence. Those had not been approved by the federal government but are expected to be permissable under President Donald Trump’s administration.

De Rocha, also a spokeswoman for KanCare, said the bidding process for those contracts ended Jan. 5 and the state expects to select companies in June.

Members of an legislative committee overseeing KanCare have raised concerns with the program’s management. Bollier, a member of that committee, said she expected legislators would review the renewal proposal this session.

Kelly said she would raise issues with renewing the program for another five years.

“That’s an awful long time to commit that much money,” Kelly said. “Plus, I don’t think we have a clear idea of what’s actually in 2.0.”