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.