Archive for Tuesday, January 3, 2012

Quick shift

Kansas officials shouldn’t move too quickly to shift the state’s entire Medicaid program to a managed care system.

January 3, 2012

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Health care providers and advocates — as well as state legislators — have ample reason to be nervous and cautious about major changes in the state’s Medicaid program.

The rising costs of the program make it a natural target for Kansas officials trying to trim the state budget or divert funds to other uses. Kansas isn’t the only state that is pursuing ways to cut its Medicaid costs — sometimes with mixed success.

Kansas already uses a private managed care provider for its HealthWave program, which serves children in low-income families. Gov. Sam Brownback now is proposing a plan that would include the elderly, disabled and mentally ill in managed care plans and to make the entire transition in one year’s time, by Jan. 1, 2013. Although other states are moving toward managed care plans administered by private insurance companies, making such a fast and complete shift is unusual. What works for children in low-income families may not work as well for elderly nursing home residents or people who need long-term assistance because of developmental disabilities.

The goal of Brownback’s plan is to cut the state’s Medicaid costs without diminishing the services Kansans receive. The administration estimates its plan will reduce overall Medicaid costs by $29 million in the current fiscal year and $277 million by 2017. It’s hard to imagine how the new system could save that much money through administrative efficiencies without having an impact on patient care.

It hasn’t worked that well in some other states. The Kansas Health Institute News Service reported on the transition to Medicaid managed care in New Mexico. The shift began in 1997 but only recently was expanded to nursing home residents. A representative of a long-term care trade group in that state noted that care providers hadn’t had a rate increase since 2007, and many staff members have gone three years or more without raises. The managed care companies took over a broken system, she said, and “didn’t fix it.”

In the last decade, two states — Oklahoma and Connecticut — have dropped their managed-care plans and returned Medicaid programs to state control, believing they could ensure better care for Medicaid patients at a lower cost.

Brownback and Lt. Gov. Jeff Colyer, a surgeon who led the task force that drafted the plan, say they will set benchmarks for managed care companies that will make sure they meet the state’s goals for both care and cost-cutting. Maybe they will, but such a quick and complete transition for the state’s Medicaid system creates a significant risk for a host of vulnerable Kansans if the plan doesn’t work out as expected. Even advocates who see some promise in the plan are concerned about details that are yet to be revealed.

It’s another case of the Brownback administration taking an extremely broad-brush approach to solving a problem when a more measured attack might better serve the state. Lawmakers should be careful not to move too quickly to upend a care system that impacts so many Kansans in need.

Comments

just_another_bozo_on_this_bus 3 years, 4 months ago

Brownback, et al, aren't concerned with improving Medicaid. They're interested in scoring ideological points while decreasing government spending in order to give the Koch Bros. even more tax breaks.

WilburM 3 years, 4 months ago

Really a first-rate editorial, with an argument backed by facts and examples, all buttressing a larger point of how the Governor makes decisions. But facts and cogent arguments don't seem very important these days, still, they are, as has been said, inconvenient for those who want to press ahead with simplistic, ideological policies.

progressive_thinker 3 years, 4 months ago

Colyer is a plastic surgeon. In other words, botox, liposuction, and breast enhancement. I do not understand how this type of practice involves a great deal of experience in working with either Medicaid or Medicare.

Getaroom 3 years, 4 months ago

If you are a hedge fund operator, or a died-in-the-wool free market capitalist, then privatizing looks like a feast about to be served right on Q and shunted back into the pockets of the super rich. Seeing as how Brownbackward is hooked up 24/7 to the Koch's Corporate IV it would be no surprise to see that happen ASAP.

You know what they say, "FM Capitalists are more than willing to have a crisis, so long as the working class pays for it. " A trade mark of the Grand ol' Party of NO!

hedshrinker 3 years, 4 months ago

Wow, it's serious when the LJW editorial staff is this critical of a Republican admin's legislative goals! I also appreciate the focus on data from other states that have pushed these ideas and their pros and cons, without resorting to lots of political name-calling and rhetoric and conspiracy theories, altho it's pretty tempting. As a longtime MH provider in both public and private systems, I have little good to say about managed care, from almost any perspective...the provider, the client, the cost-saving (minimal, without seriously compromising quality of care)....just another layer of bureacracy. Glad to know that Dr. Colyer the Lt Gov and head of the task force promoting this plan is a plastic surgeon....the only use for them is repairing damage from congenital abnormalities, accident/fire victims and of course ,IED victims. He might have dealt with the Medicare system for patients with facial skin cancer....most dermatologists refer these folks to plastic surgeons.But their bread and butter depends on the rampant body image insecurities and vanity of our population ...with disposable income. But enuf with ad hominem attacks.

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