TOPEKA In recent months, lawmakers have focused most of their attention on school funding, but it is increasing health care costs that have many state leaders even more worried.
"Medicaid, long-term, is still the most critical issue facing the state," Senate President Steve Morris, R-Hugoton, said.
Medicaid is a federal- and state-funded program that provides health care to low-income Kansans and those with disabilities.
It covers one in 10 Kansans, or about 260,000 people. That includes one in five children, six in 10 people in nursing homes and delivery costs of one in three births.
Medicaid costs about $2.2 billion annually, making it the second-largest state budget expense next to public schools. The program's medical expenses have increased 200 percent in the past 10 years.
Morris ticks off the Medicaid increases: $155 million last session, and $400 million over the two sessions previous to that.
Reforms en route
A Medicaid reform committee studied the issue for several months and produced a long list of recommendations aimed at reducing fraud, increasing the availability of long-term care insurance and giving people more information about the array of services available in communities.
Despite earlier predictions that increased Medicaid expenses would strain the state budget, the committee didn't take on the politically charged notion of trying to contain costs by making it more difficult to qualify for services.
"If you look at the long-term growth in Medicaid, it's pretty scary," House Speaker Doug Mays, R-Topeka, said. "You can't ratchet down Medicaid much because you have an aging population. Eventually, we'll be paying as much for Medicaid as we are for education."
Education funding currently is about half the state budget, while Medicaid accounts for about 20 percent.
But Congress may lead the way in cutting Medicaid. Congress is poised to act on a federal budget that would cut the projected increase in federal Medicaid funding by $4.7 billion over five years.
U.S. Sens. Sam Brownback and Pat Roberts, both Kansas Republicans, voted for the measure.
"These are very, very modest moves, but necessary moves for us to get to a balanced budget," Brownback said.
But some governors, including Kansas Gov. Kathleen Sebelius, said the reduction undermined the government's commitment to health care.
"It seems as though every time Kansas takes a step forward, Washington goes out of its way to take two steps back," Sebelius, a Democrat, said.
More community services
Meanwhile, social service advocates hope to continue the increase in home- and community-based services.
"We think the 2006 legislative session will be critical in setting future directions," said Shannon Jones, a spokeswoman for the Big Tent Coalition, a group that lobbies for increased social service funding and program choices.
Over the past 20 years, Kansas has de-emphasized the use of state hospitals and institutions for people with physical and mental disabilities, and increased funding for services to people in their homes and communities.
At the state level, the Big Tent Coalition has asked for $10.3 million in additional funding to help 1,200 Kansans with developmental disabilities who are on a waiting list for home- and community-based care. Currently, about 6,000 Kansans with developmental disabilities receive this assistance.
The coalition also has recommended changes in state law to ensure more people receive help in community-based programs instead of going to nursing homes.