By SCOTT ROTHSCHILD, The Lawrence Journal-World
TOPEKA, KAN. — Advocates for those with disabilities and chronic health conditions said Thursday that Gov. Sam Brownback's privatization of Medicaid, called KanCare, has produced numerous problems.
On a related issue, the advocates vowed to step up efforts to persuade Brownback and the Republican-dominated Legislature to expand Medicaid under the Affordable Care Act.
The issues were discussed during a meeting of the National Council on Disability, an independent federal agency that makes recommendations to the president and Congress.
The council holds four meetings per year and tries to hold two of those outside of the Washington D.C. area. Members had expressed an interest in hearing more about the managed care model under KanCare, and one of the council's members, Gary Blumenthal, is a former Kansas legislator who represented Merriam.
Brownback administration officials defended the nearly one-year old KanCare system, saying it was containing health care costs and delivering superior services. They said they expected to slow the increase in Medicaid costs by $1 billion over five years.
Under KanCare, three private insurance companies handle the health care services for nearly 400,000 Medicaid recipients.
"We have been able to expand services," while not decreasing payments to health care providers, said Kansas Medicaid Director Dr. Susan Mosier. KanCare now covers heart and lung transplants, bariatric surgeries and dental care for adults, which the old Medicaid system didn't, she said.
But critics cited numerous problems and reiterated their opposition to the state's plan to place long-term care for those with developmental and intellectual disabilities under the system. That plan is set to take effect Jan. 1 pending approval from the federal government.
Consumer sees reduced services
Finn Bullers, of Prairie Village, who is 49 and suffering from Muscular Dystrophy, said before KanCare he received in-home care around-the-clock, but under KanCare, the private insurance company reduced that to 40 hours per week. He said his doctors say that cut is unrealistic.
"There is no consistency. And if it's happening to me, it's happening to thousands of Kansans," Bullers said.
Kansas Department for Aging and Disability Services Secretary Shawn Sullivan said he couldn't speak about Bullers' case, but said under the state's old Medicaid system was flawed because organizations could propose a care plan and then provide those services. That produced conflicts of interest and resulted in some people getting more services than they needed, he said.
But Rocky Nichols, executive director of the Disability Rights Center for Kansas, said complaints to his office about services have increased 50 percent since KanCare took effect.
And, he added, many people needing in-home services wait up to 12 years.
"We believe the state is not upholding its end of the bargain," he said.
State Rep. Jim Ward, a Democrat, said hospitals in his hometown of Wichita were reporting lengthy and costly legal disputes with the private insurance companies over getting reimbursed for health care services.
Tom Laing, executive director of InterHab Inc., said the primary goal of managed care systems was to reduce costs.
"This is a way to balance the budget where tax cuts empty the treasury and then programs are pointed at as the problem. It's a little bit of a game and the loser in the game tend to be the people who are not at the table," he said.
Debate of expansion of Medicaid
The advocates also called for expansion of Medicaid. Under the federal health reform law, states can expand the income eligibility limits for Medicaid.
Twenty-six states have expanded, but most states headed by Republican governors, such as Kansas, haven't.
Under the reform law, the federal government would pay for the expansion for three years, and no less than 90 percent after that.
But Brownback's spokeswoman Sara Belfry said the governor doubted the federal promise. "That sounds a lot like, 'if you like your insurance plan, you can keep your insurance plan,'" Belfry said, referring to the President Barack Obama's earlier statement about certain insurance plans.
Expanding Medicaid eligibility would provided $350 million in federal funds for health care and cover 160,000 Kansans, Ward said.
Ward said if Brownback would push for Medicaid expansion among his GOP allies, the governor would also find support from legislators who generally oppose him on other issues.
"It really is on his desk and we await his decision," Ward said.