A new analysis of the state’s Medicaid program, KanCare, found recipients with mental illnesses often face barriers to getting the care they need, and it served as confirmation to some health advocates who have previously raised issues about the program.
Jean Hall, a University of Kansas professor and director of the Institute for Health and Disability Policy Studies, authored the study, which was released this week by the university. She said it followed up on a previous study evaluating the care received by individuals with physical disabilities.
The study found KanCare recipients with serious mental illnesses had a hard time getting information about their coverage, acquiring needed medications and finding some providers, especially specialists. Hall said fewer than 20 percent of the 189 recipients she and her co-authors surveyed had spoken with a care coordinator, someone designated to help individuals covered by KanCare organize appointments and access care. For some health advocates, that critique echoed concerns they have heard since the state rolled out KanCare in 2013.
“One of the promises of managed care is that you’ll have somebody that actually helps you manage your access to providers and manage taking care of your chronic condition,” Hall said.
The study was sponsored by the Health Care Foundation of Greater Kansas City. Hall said copies were provided to the Legislature’s oversight committee and the Kansas Department for Aging and Disability Services.
Hall said most of the beneficiaries she spoke with were glad to have KanCare and those who did access a care coordinator had good experiences.
KDADS spokeswoman Angela de Rocha said in an email the state had not been able to thoroughly review the study. She said the state agreed with some portions of the study but disagreed with others and that she thought the study was based on anecdotal comments.
Many of the beneficiaries who struggled to navigate care also had physical health conditions they needed help for, she said.
“I think it’s striking that people with mental illness also have this high rate of chronic conditions, and I don’t think there’s an appreciation that you need to treat the whole person,” Hall said.
Rick Cagan, executive director of the National Alliance on Mental Illness in Kansas, said he thought greater care coordination could help beneficiaries.
“We’re not disconnected at the neck,” he said.
Cagan said individuals with serious mental illnesses need more resources at their disposal than simply treatment for their mental illnesses because they die — on average — 25 years younger than the rest of the population.
“We also have problems with other parts of our health care, and these are connected and related, and collectively they take a toll,” Cagan said.
Cagan said while imperfect, KanCare often provides better coverage for people with serious mental illnesses than a private insurer would.
Sheldon Weisgrau, director of the Health Reform Research Project, said it was not clear KanCare was providing the integrated care people needed.
“There’s nothing really knew here,” Weisgrau said. “We’ve been hearing these issues from patients with mental illness and other KanCare enrollees since the beginning of the program.”
The study found beneficiaries sometimes did not have access to the providers they need, particularly specialists, according to the study. Nearly 25 percent of the beneficiaries surveyed had a hard time accessing certain types of caretakers, including mental health providers, pain specialists, orthopedic surgeons and podiatrists.
According to KDADS reports, beneficiaries in all areas of the state have access to behavioral health care providers. On average, providers are available within less than 10 miles for beneficiaries on two of the three KanCare plans. Podiatrists and orthopedic doctors are typically farther away.
Weisgrau said that problem was not unique to KanCare, but common among Medicaid programs in other states.
“Getting specialists to participate in Medicaid has always been problematic,” Weisgrau said. “I don’t think it’s unique to KanCare, and it’s related to the low rates that Medicaid pays.”
The Legislature this year restored pay rates for KanCare providers that were cut last year.
KanCare was also cited by the federal Centers for Medicare and Medicaid earlier this year for not adequately overseeing its provider network and ensuring the system had enough health care providers. Weisgrau said that issue was not being effectively addressed.
“This is an extremely sick population that needs far more services than just mental health services,” Weisgrau said.
Access to specialists can also form a “self-defeating” spiral, said Amy Campbell, a lobbyist for the Kansas Mental Health Coalition.
“Families are not receiving the service because there aren’t enough workers who can come in and provide the service,” Campbell said, “and if families aren’t receiving the service, they can’t be billed, which means employers are not receiving the income to hire more workers.”