TOPEKA — Kansas senators moved Tuesday toward halting an overhaul of the state’s privatized Medicaid system, KanCare, out of concern the new program could cause a cost spike without addressing grave concerns advocates have raised about the care beneficiaries receive.
The Kansas Department for Health and Environment proposed in October renewing the program for another five years under the banner, “KanCare 2.0,” and adding work requirements, lifetime caps and improvements to the system often criticized as confusing and slow. The federal Centers for Medicare and Medicaid are weighing the state’s application.
The Senate Ways and Means Committee heard testimony on a bill Tuesday that would halt that progress made by Gov. Sam Brownback’s administration. The bill will likely be amended to create a smoother process for reconsidering an overhaul, but senators wanted legislative say in the program that covers elderly and disabled Kansans.
Senators called on Brownback’s administration earlier this month to halt the reinvention over concerns about operational challenges in the program, funding for mental health and the cost of implementing and monitoring work requirements and lifetime caps.
“We’ve been told — just hallway talk — that it’s in excess of $100 million, but we’ve never been given a [fiscal] note, and that was another concern with the budget and the school bill hanging over our heads,” said Senate Majority Leader Jim Denning, an Overland Park Republican.
Sen. Carolyn McGinn, a Sedgwick Republican and chair of the committee, raised concerns that fewer elderly Kansans are accessing care even though that segment of the population is growing statewide.
“Until we can fix the current things that are going wrong in this KanCare system, I don’t see that we should be building upon the same system and moving forward,” McGinn said.
Brownback and Lt. Gov. Jeff Colyer announced last week they would delay the plan to implement KanCare 2.0.
Timothy Graham, associate director of Interhab, an intellectual and developmental disability advocacy organization, urged senators not to “double down” on the system he called a “failure.” He said as long as CMS has Kansas’ application, “KanCare 2.0 is alive and well.”
“So I want to make sure everybody understands that and doesn’t fall for the ‘We’ve got this taken care of’ line,” Graham said.
Angela de Rocha, a spokeswoman for KanCare, said in an email after the announcement the administration would revise and resubmit the waiver application and remove “cost-driving provisions.” She said that could include care coordination, a service that would help beneficiaries manage their care and access services.
“It was one of the few parts of KanCare 2.0 that had a potential upside of sort of helping to potentially rebuild some of that community infrastructure,” said Sean Gatewood, co-administrator of the KanCare Advocates Network.
Gatewood said his organization’s members were skeptical care coordination would be possible.
Interim Medicaid Director John Hamdorf testified against the bill because of the administrative hiccups he said it would cause.
“Make no doubt, I understand why it was proposed,” Hamdorf said, referencing advocates who complain they were not involved in conversations about changes to KanCare.
Hamdorf recommended modifying the state’s KanCare application rather than pulling the plug entirely so CMS would not have to restart consideration. He said CMS advised him they need a year to consider applications, but Kansas’ current version expires in 11 months.
Hamdorf also pushed for continued work on challenges in the KanCare program, like eligibility delays. KanCare has been plagued by struggles to get beneficiaries applications processed in a timely manner. The backlog makes it difficult for elderly beneficiaries to access nursing homes and puts financial strain on care providers.
Denning and Sen. Laura Kelly, a Topeka Democrat, said they would like to amend the application and get approval from CMS to extend the current version of KanCare and stop progress on the update. Kelly said she thought the Legislature needed to step in rather than relying on Brownback’s administration to halt the program.
Denning said Brownback’s coming departure and Colyer’s transition to the governorship necessitated legislative involvement.
“It’s very odd for the legislature to get involved, but we’re going through the transition, and we just wanted to let our constituents know and the advocates know that we’re going to stop it,” Denning said.