Topeka Reform of Medicaid, a program for low-income people, tops the health care agenda for Lawrence's senator.
A life spent with a health care provider led Sen. Sandy Praeger, R-Lawrence, to chair the Senate Public Health and Welfare Committee.
It will be from Praeger's seat in 526 South -- the committee's meeting room -- that her grasp of medical issues will be tested this legislative session.
She will lead a crucial Kansas policy debate designed to prepare for the federal government's conversion of Medicaid to a block-grant program operated by states with fewer federal strings.
"We've got to be ready," said Praeger, wife of a Lawrence doctor. "Are we going to continue business as usual ... or do we make modifications on eligibility requirements?"
Medicaid, a medical assistance program for low-income people, serves 7,255 residents of Douglas County. There are 288,742 clients in Kansas. Medicaid consumers are primarily women, children and the disabled. Federal Medicaid funding to Kansas is $713 million annually.
It's unclear what federal legislation authorizing block grants -- known as a MediGrant -- will look like. The bill is part of protracted negotiations between President Clinton and Congress.
"It is difficult to predict the outcome of the debate on federal health care entitlements," said Rochelle Chronister, secretary of the Kansas Department of Social and Rehabilitation Services.
She said the bill could mandate specific groups -- pregnant women living in poverty, for example -- be served by Medicaid.
But the federal government likely won't require states to cover specific services, reimburse health care providers at certain rates or provide services of the same scope to all people.
Pressure is on Praeger and other legislators to draft a plan by Aug. 1 that articulates Kansas' strategic objectives and performance goals for Medicaid. In all likelihood, no state will receive Medicaid funds without a plan.
Praeger said committee hearings would be conducted to assess objectives and goals. A public advisory committee will contribute.
If Congress and Clinton reach agreement on Medicaid reform after the '96 session ends, the Legislature could meet in special session to pass laws necessary to assume control of Medicaid.
"We can ensure there's no lengthy session if we've done a lot of the preliminary work," Praeger said.
Praeger said a cap on federal appropriations for Medicaid ultimately could create budget problems for the state.
"In the past, as economic conditions in the state changed for the worse, we got an increase in federal dollars for people on welfare," Praeger said. "Not any more. Eventually, any increases in spending would have to be covered by the state."
Praeger welcomes efforts to get Medicaid away from the federal bureaucracy. She said the state wastes money complying with federal reporting requirements instead of helping people.
She's not interested in changing Medicaid programs just to comply with a political agenda.
"We must ensure the state doesn't abdicate its responsibility to people in need," she said.