KanCare proposal raises concerns

I would like to share my concerns regarding the proposed global changes to state-Medicaid-based programs and services, and particularly, the community-based supports, that thousands of Kansans with intellectual and developmental disabilities (I/DD) depend upon each and every day.

KanCare may provide opportunities to increase efficiency of medical care for individuals with I/DD. We support the focus on competitive employment and the goal to increase opportunities for independence and integration for people in services.

However, the impact of inclusion of long-term supports and services is something that remains unclear.

Other states, such as Texas, have studied the inclusion of I/DD services in managed care and have decided to carve them out as there was no cost savings.

We have been told the administration has evaluated other models on the implications of including I/DD long-term supports and services in managed care. However, we remain unclear on the details that have been evaluated and evidence these models can be replicated in Kansas.

As it stands now, four states have included long-term care services for individuals with I/DD in their managed care plans and they all vary in different ways.

While medical needs of individuals with I/DD were covered by managed care models, their day, residential and case management were not.

That is significant.

Until recently, Secretary Sullivan has contended that no changes would be made to the I/DD system. Consumers could keep their case manager and the CDDOs would continue to operate in the current manner.

The secretary relates that our system, since it runs so well, would operate as a parallel system within the KanCare plan.

Then just a short week ago we were informed that under KanCare, our system would continue to operate as usual for the short term ...?

Can you imagine how this one statement has heightened our anxiety on what do we tell the individuals in service and their families?

It is too much change, too fast, by an administration that does not fully understand our system.

Please allow me to list some questions we have asked our legislators:

KanCare will be the largest financial transaction in our state's history.

Is there sufficient time for the Legislature to exercise sufficient due diligence to assure that this plan will be adequately devised, implemented and safeguarded?

The state's primary safety net investment for individuals in need (low-income children, the elderly and those with disabilities) will now be entrusted into a plan never before attempted in the country?

Should additional time be required to address remaining unanswered questions and issues?

Is it a proper delegation of legislative and executive oversight that the I/DD community network, its families and individuals served be placed at a distant arm's length from both the administration and the Legislature, separated by an administrative wall of three separately empowered national for-profit companies?

Finally, if KanCare goes forward as proposed, is the Legislature prepared to consider how it will respond, after adjournment, in the event that the eventual contracts issued for KanCare are different than the assurances that have been offered in this process?



Garden City

Reynolds is executive director of Mosaic in Garden City.