Topeka For years, legislators have been frustrated by the rising cost of helping needy Kansans through Medicaid, gobbling dollars that could go to public schools, universities and other programs.
Legislative leaders throw around phrases like "runaway train" and "out of control." Over the past decade, the state's payments to doctors, hospitals and clinics for Medicaid services have more than tripled, to $1.5 billion.
Yet legislators also have continued to pay the bigger bills because trying to rein in costs means cutting off needed medical care.
They may have to do it next year, pressed by a looming budget shortfall and judicial demands to increase education spending. Seeing the train coming down the tracks, legislative leaders have formed a special committee to examine Medicaid this summer and fall.
"We have to take another hard look at what we're doing," said Senate President Steve Morris, R-Hugoton. "We cannot sustain what is happening."
Medicaid is a federal program administered by the states. Typically, for each $1 the state spends on Medicaid, the federal government chips in $1.50.
In Kansas, eligibility for services depends on a family's income and the age of its members. For example, a married couple with two children and a pregnant mother can't have a household income of more than $29,000.
Cindy D'Ercole, lobbyist for Kansas Action for Children, said more than half of the people covered by Medicaid in Kansas were children under 18.
She sees value in a study of Medicaid - educating legislators about the program and demonstrating that cutting services is not a good choice.
"It provides some really essential preventative services to children and pregnant mothers," D'Ercole said.
However, legislators are going to be thinking about saving money when they examine Medicaid. Under pressure from the Kansas Supreme Court, legislators increased spending on public schools more than 10 percent this year, by $290 million, but the court has said it could demand further increases next year.
Even with that pressure, legislators will have a difficult time raising taxes next year, especially because all 125 House members face re-election. Proposals to expand gambling have failed, no matter how hard casino developers try.
Those facts force legislators to consider spending cuts - and Medicaid is a big item in the budget. House Appropriations Committee Chairman Melvin Neufeld said many legislators don't understand how big - or how expensive - Medicaid is.
"They don't understand what the growth potential is and where it's going to go," said Neufeld, R-Ingalls.
But Shannon Jones, a lobbyist for the Statewide Independent Living Council, worries many legislators may not see the real problem.
She says it's not Medicaid but rising health care costs; the state is facing problems many businesses face in offering health insurance to their employees.
Furthermore, she said, cutting the safety net may result in short-term savings but higher long-term costs. For example, if the state reduces spending on in-home services for the elderly and disabled they're likely to go into nursing homes which will cost taxpayers more.
Jones and other advocates are likely to be arguing that case plenty next year, after the Legislature convenes Jan. 9. The Medicaid program will have a big target painted on its back.