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Archive for Thursday, January 5, 2012

Advocates urge slowdown on part of Brownback’s Medicaid overhaul

Douglas County legislators on Thursday met with representatives of area organizations to talk about issues in upcoming legislative session. From left to right, facing forward, are state Rep. Paul Davis, D-Lawrence, state Sen. Marci Francisco, D-Lawrence, state Rep. Barbara Ballard, D-Lawrence, state Rep. TerriLois Gregory, R-Baldwin City, state Rep. Tom Sloan, R-Lawrence, and state Sen. Tom Holland, D-Baldwin City. They were speaking with Steve Solomon of The Farm — Douglas County Visitation Center. The legislators met with officials from more than a dozen organizations during a meeting at the Lawrence school district headquarters.

Douglas County legislators on Thursday met with representatives of area organizations to talk about issues in upcoming legislative session. From left to right, facing forward, are state Rep. Paul Davis, D-Lawrence, state Sen. Marci Francisco, D-Lawrence, state Rep. Barbara Ballard, D-Lawrence, state Rep. TerriLois Gregory, R-Baldwin City, state Rep. Tom Sloan, R-Lawrence, and state Sen. Tom Holland, D-Baldwin City. They were speaking with Steve Solomon of The Farm — Douglas County Visitation Center. The legislators met with officials from more than a dozen organizations during a meeting at the Lawrence school district headquarters.

January 5, 2012, 6:02 p.m. Updated January 5, 2012, 8:40 p.m.

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Health care advocates on Thursday criticized a plan by Gov. Sam Brownback to turn over management of services for those with disabilities to for-profit companies.

"We really need to have this process slow down," said Sharon Spratt, chief executive officer of Cottonwood Inc.

Brownback and Lt. Gov. Jeff Colyer are moving to overhaul Medicaid, which is the state and federally funded health program for those with disabilities, the elderly and low-income residents.

Medicaid covers approximately 350,000 Kansans at a cost of nearly $2.8 billion.

Brownback wants to contract with private managed care companies to handle the program, calling it KanCare. Companies are scheduled to submit their bid proposals by the end of the month.

The Brownback administration has promised that KanCare “will improve coordination of care and services to achieve better outcomes and long-term savings without reducing benefits or eligibility, while safeguarding reimbursements for providers.”

But unlike most other states that have adopted the managed care model, Brownback also wants to add services for those with developmental disabilities.

That has raised alarms in organizations such as Cottonwood that provide services to people with developmental disabilities.

Spratt and other service providers spoke with members of the Douglas County legislative delegation. The meeting was being held in preparation for 2012 legislative session which starts Monday.

Spratt said there is no model in the nation where managed care companies have succeeded in meeting the long-term needs of people with severe disabilities.

"These individuals are not `sick,' but have life-long disabilities, and with adequate supports can enjoy a full and meaningful life," she said.

State Rep. Barbara Ballard, D-Lawrence, and other legislators, said they have heard numerous questions about the Medicaid proposal and planned to seek answers at hearings during the session.

"Everybody is concerned," Ballard said.

Representatives of other area organizations said they hoped that with state revenues running approximately $300 million more than projected, legislators would help restore funding for services that have been damaged by budget cuts over the past couple of years.

Stacey Hunter Schwartz, executive director of Independence Inc., said there are 3,369 persons with physical disabilities on a waiting list to receive assistance that would keep them in their homes and avoid having to be place them into more expensive nursing home care.

"In the name of saving money, we are actually spending more," she said.

Comments

thebigspoon 2 years, 7 months ago

Yes, ladies and gentlemen, here is smaller government exiting the lives of those who most need it. Quite a good idea, Sam. Make life harder for those who probably did not and never will vote for you, anyway.

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Cant_have_it_both_ways 2 years, 7 months ago

If there weren't so many that could work living off the taxpayer, then this would not be a problem.

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Jeff Barclay 2 years, 7 months ago

Our little girl has a developmental disability. I need some more explanation here. All we have noticed so far are efforts (somewhat inconvenient) to element fraud. But I would be totally opposed to any efforts disguised as eliminating fraud, only to see services to our daughter cut. Let's throw out party politics and explain what has been proposed a bit better. One thing that has happened is that our daughter's money no longer passes through three very redundant non-for-profit (?) agencies before we see a penny. Is is possible that a private company could be more efficient? Just asking. I will say this, if Brownback is trying to slip in a drop in support services to the developmentally disabled, then shame on him. Seriously, shame on him.

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xclusive85 2 years, 7 months ago

I agree with you 100%. We need more information on exactly what is proposed.

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jafs 2 years, 7 months ago

The proposal, as I understand it, is that 3 private companies may be administering the new system.

So, we'd have 3 different private companies instead of the current system.

I don't see how that could possibly save money and improve services - I predict you'd see a drop in services instead.

Also, of course, government funding for dd is supposed to go to care providers, not directly to families, so I'm not sure what you mean there.

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xclusive85 2 years, 7 months ago

I am a little confused about the following from the story:

"But unlike most other states that have adopted the managed care model, Brownback also wants to add services for those with developmental disabilities.

That has raised alarms in organizations such as Cottonwood that provide services to people with developmental disabilities."

Did anyone else read it as Sharon is concerned about adding services for people with developmental disabilities? Wouldn't adding services be a good thing?

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deec 2 years, 7 months ago

Add is used here to mean include, as in, unlike all other states, disability services will be included in the private for-profit contracts. It does not mean new or more services will be provided.

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xclusive85 2 years, 7 months ago

Gotcha! Makes much more sense that way.

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mloburgio 2 years, 7 months ago

In the Tea Party’s America, families must mortgage their home to pay for their mother’s end-of-life care. Higher education is a luxury reserved almost exclusively to the very rich. Rotten meat ships to supermarkets nationwide without a national agency to inspect it. Fathers compete with their adolescent children for sub-minimum wage jobs. And our national leaders are utterly powerless to do a thing. coming to a teaparty near you these cuts!

Social Security and Medicare Medicaid, children's health insurance, and other health care programs All federal education programs All federal antipoverty programs Federal disaster relief Federal food safety inspections and other food safety programs Child labor laws, the minimum wage, overtime, and other labor protections Federal civil rights laws

http://www.americanprogress.org/issues/2011/09/tea_party_constitution.html

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ignatius_j_reilly 2 years, 7 months ago

Both Brownback and this article could be more clearer.

"But unlike most other states that have adopted the managed care model, Brownback also wants to add services for those with developmental disabilities.

That has raised alarms in organizations such as Cottonwood that provide services to people with developmental disabilities."

Of course Cottonwood Incorporated doesn't like this -- it means that a larger, more efficient company will partially or totally replace it. But why is that bad for us, Joe and Jane Taxpayer? If anything, this seems like a way to create efficiency in government (good) without taking away benefits (good), and to create tax dollars rather than grow our public sector (good).

Maybe I'm not understanding things here, but it seems like the only reason people are getting mad or worried is because this contractor would be adding to its managed care duties (being more efficient), which might bankrupt places like Cottonwood.

Someone explain this to me. Why would anyone consider this a bad thing, other than a company like Cottonwood, which stands to lose business?

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kochmoney 2 years, 7 months ago

Joe and Jane Taxpayer are likely not to see any savings from this system at all. All they'll see is crappier services provided to their loved ones. Other states have tried managed care, and mostly it doesn't provide "efficiencies" so much as it limits access to doctors, removes providers, and limits the ability to see specialists. In the case of developmental disabilities, it takes the most vulnerable community and usually eliminates independent case management, and it takes a population that needs highly individualized care and services and tries to make them "efficient" with a one size fits all model, which is to the detriment of the population being served.

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George_Braziller 2 years, 7 months ago

Case managers would also no longer be able to coordinate services based on the needs of the individual. They would become agents of the insurance companies and have to coordinate services based on what they think the individual needs.

A friend of mine has been an independent targeted case manager for the DD Waiver for the last seven years. She's a damned good case manager and regularly works 50-60 hours a week because she's passionate about providing the highest level of service possible. If it's turned into managed care she's going to get out of case management because she refuses to work for an insurance company which would require her to manage services based on a cookie cutter formula.

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BigDog 2 years, 7 months ago

Ever wonder if some of these organizations like Cottonwood are more concerned about the impact on their bottom line than the impact on the person. The whole for-profit/non-profit is a mute point because many of these "non-profit organizations" have quite sizeable foundations. Many of their foundations were built up by rolling the profits over to the foundation side. Once in the foundation they have less restrictions on how these funds may be used.

If done correctly (and I emphasize "IF") the coordinated care system would be beneficial for many of these individuals ... currently their health care needs, mental health needs and developmental disability needs are fractured and 3 different organizations involved and not communicating well with one another in most cases.

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kochmoney 2 years, 7 months ago

If that's the problem, the duties should be absorbed by the state instead of being managed by a separate for-profit entity. Managed care is roundly unpopular with disabled communities pretty much everywhere, not just the non profit organizations that service them.

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ems1013 2 years, 7 months ago

What you fail to understand is that if organizations like Cottonwood's bottomline drops anymore than it already has, they no longer have the funds to pay for the staff that they need to serve their individuals. Would you drop whatever job you have and come work a "slightly more than minimum wage" job with people whose needs you don't seem to understand? These jobs may include lifting persons, toileting persons, changing someone's soiled clothes, being hit, kicked or bitten, waking them up overnight to use the bathroom, being drooled, urinated or defecated on, bathing someone, feeding someone, cleaning up feces and urine, etc. Those may be examples on the more severe side of things, but not at all uncommon.

Organizations in the CDDO (Community Developmental Disability Organization) already operate similarly to managed care. There are tier systems which determine level of funding based on that person's annually assessed needs. There are funding caps at each tier level which means that all people with the same tier receive the same amount for their services and different tiers receive differing amounts of funding because their disability is more or less severe. There's already a gatekeeper to the system and people must meet specific requirements to able to enter the system.

Managed care may be a decent model for medical care; I'm not even going to argue to that end. But we're talking long term care which includes many more facets than just medical and are actually interested in the person's quality of life. Medical models don't always understand the long-term needs of these people just to be able to live a decent life and wouldn't necessarily be concerned about how happy they are with their life.

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Ronnie24 2 years, 7 months ago

As someone that is totaly disabled, (Can not work), this makes me very scared. I have a problem making ends meet EVERY month. How will this affect people like me? There would be no way to see my Dr. or get my meds or any future surgeries I might need. It seems Brownbeck dosent give a rats --- for anyone that doesent have any other resources. I feel so much for those that are worse than me. How will they make it if there are any more cuts to their programs. I agree we need MORE info on these for-proft co .that Brown. wants to take over these services.

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Don Whiteley 2 years, 7 months ago

Most of the comments I see here seem to come from the liberal side of the house. I admire liberals for their concern about the welfare of our disadvantaged citizens. However, liberals never want to consider the cost of this care within the current budget. They instead, prefer to defer these costs to our children and grandchilldren. I don't always like where the current administration makes cuts, but cuts have to be made and our generation MUST be responsible for paying for our own way.

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kochmoney 2 years, 7 months ago

It's our grandchildren who will pay if we kick the can down the road by providing inadequate DD services to children. It's our current generation who will pay if we're stuck using higher cost nursing homes for disabled loved ones who could be cared for at home under waiver programs, and that's exactly the sort of scenario that could happen under managed care "efficiencies."

Our goals are one on the same. If managed care systems were truly more efficient, I'd be in favor of them. I fear that this system will cost us all more and serve us less.

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jayhawkinsf 2 years, 7 months ago

Are all people entitled to equal services? A person born with a developmental disability has done nothing wrong to deserve this. That person, in my opinion, is entitled a quality services for their entire life. It's what a civilized country must do. But what about a person who chooses to use an inhalant until such a time as his/her brain is damaged sufficiently that on a cognitive level, they are equal to the person born with a developmental disability. Is that person entitled to the same quality care? Does an adult who suffers a traumatic brain injury from a motorcycle accident when they chose not to wear a helmet deserve the same care as a child who suffers a similar injury resulting from a bicycle accident? What if the adult was injured while skydiving? While these are very difficult choices to make, the fact is that we may get to the point when these choices will have to be made. We may already be there. We might have to choose between lowering the level of care for everyone or providing higher care for some and lower quality care for others.

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kochmoney 2 years, 7 months ago

Yes. They all deserve services. No, we're not going to have to set up death panels to decide who gets to see a nurse and who gets to live in the more expensive jail system to have their needs for basic care met. The adults in the situations you mentioned likely were taxpayers and paid into the system that is now used to care for them. We're also not going to decide if that emphysema was from working in the coal mine or smoking.

The choice we're making is whether we should fund the services we'll likely need ourselves someday or if we should continue to coddle the rich with more tax cuts in the hopes that someday they'll build those airplanes in Wichita and not Washington.

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volunteer 2 years, 7 months ago

I keep thinking of the two Pennsylvania judges who received kickbacks (one got a million bucks) from the builders of the PRIVATE prison to which they sentenced juveniles for minor infractions. Let's be careful and think through possible pitfalls whenever we switch from traditionally government-run to privately run programs.

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KansasPerson 2 years, 7 months ago

Some of you (Ignatius, BigDog) seem to be missing the point (as well as doing a big disservice to people who work with folks with DDs -- you just can't do that work unless you have a passion for it!).

Managed care companies are about making a profit. They do this by offering incentives.

This model may work with health care (and many would argue that!) but it does not fit at all with this population. Pay attention to what Sharon Spratt said in the article. These people are not "sick" and there is no "cure." Working with people with DD means helping them have, as she says, a full and meaningful life. This simply does not fit in with an incentives-based managed care model!

Ignatius, BigDog, and others who are thinking it's all about the bottom line for places like Cottonwood -- you should learn more before you run off your mouths! This change would make things very bad for the people served, which is the big concern. Do you really think that case managers are in their jobs for the money? You've got to be kidding!

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jhawkinsf 2 years, 7 months ago

And politicians' first duty is to be elected. Not to the truth. Not to their constituency. So should they be mistrusted in all their statements and actions? After all, their actions are the workings of government. Should every action, every government policy be discounted? Both government and the private sector need to be looked at carefully. Neither should be given a free pass and neither should be dismissed out of hand.

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BigDog 2 years, 7 months ago

KansasPerson

I worked in services to people with developmental disabilities for 7 years .... I did the residential side as well as policy and adminstrative sides.

Yes many of the providers don't pay well while at the same time have large foundations and build nice offices. The money is there somewhere.

I am not saying it is about the bottom line but that is also a system that the state has chosen to ignore the income of the parents for the most part. So you can be a doctor/lawyer couple and the state bases eligibility upon the income of the child. In this case the child receives Medicaid and their services are paid for by the tax payers.

I find it interesting that KansasPerson you have boughted into the Interhab/Cottonwood propaganda that the system will be horrible for persons with developmental disabilities when there is only an RFP out there .... there is no managed care providers who have even sent in a proposal. How do you know how it is supposed to work for the people?

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Jean Robart 2 years, 7 months ago

Maybe they'll do something about the ridiculous spenddown for Medicaid services. I am disabled--would work if i could-and have a six month spenddown of around $5000--that's before Medicaid pays for anything. I only get $1300/month for my disability. The state of Kansas Medicaid base line amount is under $500. That means they figure a person--or family--can manage on less than $500/month for rent and all expenses. Shame on you Kansas legislature for not doing something about this in over 30 years.

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KansasPerson 2 years, 7 months ago

That is a lot of money to be just handing over to some corporation to manage.... maybe not even a corporation in our state. Conservatives often think liberals are too free with the taxpayers' money, but is this proposal not being a little too free with our money as well?

And you, taxpayer, are not even going to get a say as to what corporation gets chosen. It's all in the bids. And who knows what else.

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overthemoon 2 years, 7 months ago

yep. privatization is the road to disaster. the incentive of a profit driven system is to minimize costs and outcomes and maximize profits. that doesn't bode well for anyone but the stockholders. we've been there, done that, but still people press on about turning the corporate monsters loose at every turn.

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Notabonehead 2 years, 7 months ago

I hope this alerts the Christian right to how ludicrous it is that there big money politicians advocate for the "right to life" but not for the "right to live."

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overthemoon 2 years, 7 months ago

Connecticut has reverted to state managed care after finding that managed care by private insurers is too expensive, inefficient, and deficient. think it will take Kansas 15 years to figure that out all on its own?? Why outsource to a corporation from another state?? Keep the money and the control local.

http://www.kaiserhealthnews.org/Stories/2011/December/29/Connecticut-Drops-Insurers-From-Medicaid.aspx

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jayhawklawrence 2 years, 7 months ago

In the interest of being open minded, I would like to see some verifiable examples of changes that can be attributed to Brownback that have actually benefited Kansans and I would like to know if the pattern of change suggests chronic screw ups or if this is just my impression.

Verifiable would mean facts of course.

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jayhawkinsf 2 years, 7 months ago

"In the interest of being open minded" - That's the very last thing you are being, as the rest of your comment clearly suggests. I didn't vote for Brownback, I don't like his policies and I can't imagine a scenario where I would vote for him in the future. That last part suggests I'm being closed minded, as are you. Why not just admit it?

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Clark Coan 2 years, 7 months ago

Medicare and Private Health InsurancePublished: December 9, 2011 Medicare is much more efficient and less costly than private health insurance. So, privatization will increase costs. See below:

New York Times
To the Editor:

Jordan Awan “What About Premium Support?” (editorial, Dec. 4), about federal vouchers to control the cost of Medicare, did not mention a compelling reason for not relying on private insurance.

It is generally agreed that this industry adds 15 to 20 percent to the cost of its premiums to pay for its business overhead and profits, whereas the administrative costs of Medicare are less than 5 percent.

The Centers for Medicare and Medicaid Services actuary estimates that private insurance overhead this year will amount to $152.1 billion and will continue to rise more rapidly than the total cost of health care in the years ahead.

Turning more of the Medicare system over to private insurers would divert still more money into the pockets of this industry, taking it away from the direct provision of health care. Isn’t it time to consider how best to reduce — rather than increase — the role of this unneeded middleman industry, with its unnecessary and huge overhead?

ARNOLD S. RELMAN Cambridge, Mass., Dec. 4, 2011

The writer, professor emeritus of medicine and social medicine at Harvard Medical School, is a former editor in chief of The New England Journal of Medicine.

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jayhawklawrence 2 years, 7 months ago

I will help this get started then...

I like the 75 mph speed limits. Great for me! Thanks Governor.

Next?

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