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Kansas legislature

Kansas Legislature

Brownback’s Medicaid plan sparks uncertainty, as well as hope

December 30, 2011

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Prompted by rising costs that squeeze the state budget, Kansas plans to overhaul its Medicaid program — something that makes advocates for the needy and health care providers nervous as Gov. Sam Brownback’s administration looks for savings.

The Republican governor’s administration promises that its changes will achieve the savings without reducing coverage for the disabled, elderly or poor families or cutting payments to the doctors, hospitals, clinics and nursing homes. Brownback and his top advisers contend Kansas can avoid ugly choices made in other states by managing care better and more aggressively promoting healthy living.

Legislators and advocacy groups agree with the goals and see some promise in the initiative. But some remain skeptical that the changes will deliver the pledged savings in one of state government’s biggest annual expenditures. They say they’re nervous because they’re uncertain about how the changes will play out, particularly because Medicaid would be managed through private contractors.

The talk of change also is likely to make some Kansans covered by Medicaid uneasy. Jennifer Masenthin, a 29-year-old mother of three in Quenemo, a town of 400 about 35 miles southeast of Topeka, is grateful for the coverage Medicaid provides for her family. Her husband is a part-time farm worker, and she cares for their three young children, taking her oldest, a 9-year-old girl, to the Kansas City area for treatment of a disorder that has her body producing too much insulin.

“I’ve got something that is working well,” she said of their Medicaid coverage. “You shouldn’t have to stress.”

But state officials consider the current Medicaid program a source of financial stress as it covers health care for about 330,000 Kansans. Annual expenditures now approach $2.8 billion, and Brownback’s administration projects they’ll exceed $4 billion by 2017, without considering changes imposed by the federal overhaul of the health care system.

States are preparing for an expansion of Medicaid under the 2010 federal health care law championed by President Barack Obama, while worrying that because of its budget problems, the federal government will back off its traditional commitment to cover about 60 percent of Medicaid costs.

Other states, including Arizona, California and New Jersey, have sought to limit eligibility, reduce benefits or cut payments to health care providers. In 2009, then-Kansas Gov. Mark Parkinson, a Democrat, imposed a temporary 10 percent reduction in payments to providers.

Kansas Lt. Gov. Jeff Colyer, a surgeon and former state senator who led the task force drafting the plan, said Brownback, who took office in January, wants to avoid such decisions in the future.

“Give me a better option,” Colyer said. “I don’t see how cutting rates or cutting people off the system gets us better results.”

Brownback’s administration plans to have three private companies administer Medicaid statewide, with recipients choosing among the firms’ plans. The state already has two private contractors administering health coverage for poor and working-class families with children, but Brownback’s overhaul would pull in coverage of the disabled and elderly.

Bids from prospective contractors are due Jan. 31. The administration said three-year contracts, which start in 2013, will include goals, such as moving mentally ill and disabled Kansans into jobs, providing comprehensive care for diabetes and integrating physical and mental health care. The plan also is designed to ensure that Medicaid clients have a medical “home” and coordination among different providers.

The plan also includes reorganizations of the state’s health, aging, juvenile justice and social and rehabilitation services departments.

Brownback’s administration projects that the changes will reduce overall Medicaid costs by $29 million during the current fiscal year, which ends with June. By 2017, the total annual savings will be $277 million, the administration projects.

Many changes will be handled through the contracting process and in negotiations with the U.S. Department of Health and Human Services, Colyer said. Legislators will review the overhaul as they draft a state budget and must sign off on reorganizing state agencies.

Advocates said they don’t yet feel they have enough details about how the state will monitor whether the Medicaid contractors are meeting goals and worry about how the companies will work with groups that have traditionally provided services, particularly for the mentally ill and developmentally disabled. They’re concerned some providers won’t want to deal with three contractors if their administrative practices aren’t consistent.

“Is the administration leaving a back door open in case it doesn’t work out?” said Anna Lambertson, executive director of the Kansas Health Consumer Coalition.

Jerry Slaughter, executive director of the Kansas Medical Society, said the physicians it represents generally remain optimistic but still see a risk of reduced payments from the state if savings don’t materialize.

Colyer said he understands that advocates, health care providers and others are worried because, “nobody likes change.” But he said keeping the current system will inevitably force the state to cut coverage or lower providers’ payments.

“When you take those things off the table, then you’re left with doing this better overall,” he said.

Comments

mloburgio 2 years, 11 months ago

Kansas not pursuing federal prevention dollars The federal government is poised to start spending $900 million nationwide over the next five years in an effort to battle costly chronic ailments such as obesity and diabetes. http://www.khi.org/news/2011/aug/08/kansas-not-pursuing-federal-prevention-dollars/

KEITHMILES05 2 years, 11 months ago

The idea of these recipients living a "healthier" lifestyle is absolutely false and laughable. These people have no incentive whatsoever to do so because the "system" pays the bills. They have nothing at stake, nothing at all.

lucky_guy 2 years, 11 months ago

Keith what are you threatening them with then? To turn them out on the street? What street, nobody wants them now? Brownie says get the mentally disabled jobs. What jobs would that be? CLO makes straps for cargo, do you expect a computer assembly plant to open up using KS mentally disabled? Not likely. There is no incentive because we have made none. We will have to build the infrastracture to make this work and I see no investment here. This is all "magical" thinking.

littlexav 2 years, 11 months ago

Oh, they think costs can be lowered by "more aggressively promoting healthy living"? Good thing they gutted KHPA last year...

jhawkinsf 2 years, 11 months ago

Whenever Medicaid is discussed, I'm reminded of an interview with a senator (his name escapes me) I heard on NPR about a year ago. He recalled during debate that the GAO estimated costs for the program and the Senate voted in favor of the bill. Years later, it came to pass that the costs were 10 times what the GAO had estimated. It was the opinion of that senator that had the true costs been known at that time, the bill (and medicaid itself) would have gone down to defeat. Now, I'm not saying all Medicaid is bad. But I agree with that senator when he implied that costs must be considered when judging the value of any given program. If the costs of Medicaid, Medicare, Social Security or the Defense Department rise at unsustainable rates, none should be immune to drastic cutbacks.

William Weissbeck 2 years, 11 months ago

Except the poor have no voice. When St. Lawrence was ordered by a Roman Prefect to turn over the treasures of the church, he presented the poor, the crippled, the blind and the suffering, and said that these were the true treasures of the Church.

jhawkinsf 2 years, 11 months ago

I believe that a poor person and a wealthy person have exactly one vote each.

William Weissbeck 2 years, 11 months ago

But the rich man can spend his money to influence others of his views. All the poor can do is be poor. I could take your views much more seriously, if in fact there was even a remote chance that our military industrial complex can be reduced. But we need only to look at GOP threats on the defense budget triggers and Boeing's threat to the state of Kansas to see who is holding a real loaded gun to our heads.

jhawkinsf 2 years, 11 months ago

I was listening to the radio just yesterday, NPR again. They were discussing a huge sale of Boeing fighter jets to Saudi Arabia. Of course I wondered if those jets might be used against us in the future, much like weapons we sold to Iran, Iraq or even to those fighting the Soviets when they invaded Afghanistan. Yes, a huge coup for the military industrial complex. But the report also mentioned that the sale would provide for 50,000 American jobs. In these times, it would seem foolish to turn down all those jobs. The point is that is never quite that easy. Fighter jets to a foreign country sounds like "military industrial complex" while 50,000 jobs sounds like "social programs". Which is it? Maybe some of each, depending on how you look at it.
But getting back to the rich man poor man argument. The rich man can spend money to try to influence a poor person. Whether or not he's successful at being influenced is completely up to the poor person. In that regard, the poor person has more power because he and he alone decides if the expenditures of the wealthy are going to be wasted.

Bob Forer 2 years, 11 months ago

Both of you are forgetting one simple fact. The cost of running for national office is over a million dollars for a house seat, and several times that amount for the U.S. Senate. The problem is more about access than influence. Unless you are independently wealthy, and/or have the backing of the two-party machine and their wealthy donors, you don't stand a chance of being heard. We have democracy in name only. It sold out to special interest groups and the wealthy a long time ago.

Public financing of political campaigns is the only solution. But do you think either party is going to pass such legislation? Yeah, and monkeys might fly out of my butt.

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