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Archive for Wednesday, July 2, 2014

Kansas abruptly halts new Medicaid service before it begins

July 2, 2014

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— State health officials in Kansas on Monday abruptly halted the launch of a new Medicaid service in Kansas less than a day before it was set to begin, leaving agencies like Heartland Community Health Center in Lawrence in a lurch.

"We're going to have to scramble," said Jon Stewart, CEO of Heartland, which had intended to provide the service to Douglas County residents. "We put a ton of time and energy into making this happen. ... But this delay, it was incredibly disruptive."

The new service, known as a "health home," is intended to provide intensive case management for two high-cost populations: people with chronic medical conditions such as diabetes, asthma or heart disease; and people with severe mental illness.

A little-known provision of the federal Affordable Care Act, also known as Obamacare, gave states the option of offering the service through their Medicaid programs. The idea was that the Medicaid programs would contract with providers such as Heartland, who would help coordinate all the medical care for those patients and help them learn how to make appropriate health care decisions for themselves.

Under the Affordable Care Act, the federal government would pay 90 percent of the cost of the health home services for the first two years, rather than the 57 percent it pays for most other Medicaid services.

The goal, Stewart said, is to improve the quality of care they receive and, ultimately, lower the cost by reducing otherwise avoidable costs. He said Heartland had already identified as many as 300 to 500 patients in Douglas County who would qualify for the service, and he expected that number to grow after the program was launched.

But Monday afternoon, the day before the new program was to begin enrolling patients, the Kansas Department of Health and Environment, which manages Medicaid in Kansas, sent out an email saying it was delaying the start of the home program for the chronically ill, at least until January.

KDHE spokeswoman Sara Belfry said the agency plans to move forward with the health homes for people with severe mental illnesses. In Douglas County, the Bert Nash Community Mental Health Center is expected to provide health home services for people with mental illnesses.

But health homes for people with chronic conditions are being delayed because the agency couldn't find enough contractors to cover the whole state.

Under federal rules, Belfry said, the state must be able to offer patients a choice of at least two providers before the state can take part in the program.

"We did not have the network adequacy," she said.

The Kansas Medicaid program was privatized early in Gov. Sam Brownback's administration and is now known as KanCare. The program is managed by three contractors, or Managed Care Organizations.

Belfry said the reason for the short notice was that state officials were hoping those companies would have enough contracts signed before July 1 for Kansas to qualify for the program.

"They weren't and we weren't comfortable enrolling people in a program that didn't give them choice," she said.

But for agencies like Heartland Community Health Center, Stewart said, the lack of notice created numerous problems.

Stewart said Heartland had already hired two new staff members to work in the health home program and was in the process of recruiting two more.

"This leaves us in serious limbo," he said. "The energies we've spent recruiting — what do we do there? How do we engage these people? What damage has been done in that recruiting relationship?"

Stewart said he remains hopeful the state will eventually move forward with the health homes program, even if it takes until January, because he believes it will be beneficial.

"I'm frustrated, to put it mildly, with the way this has transpired," he said. "But again, the program is outstanding. We've seen research on how effective it's been in Missouri and Iowa."

Comments

Larry Sturm 5 months, 3 weeks ago

Our so called christian governor does not care about the sick and the poor maybe he prayed about it on Saturday and it hasn't happened yet. Brownback will get his in the end. BROWNBACK BAD FOR KANSAS.

5 months, 3 weeks ago

If it wasn't for Lawrence I wouldn't be living in Kansas. I'm not getting any younger. Financially, being a member of the working class, it's making a lot more sense to move to another state. I really don't want to...but there is no doubt that my sense of well being has been eroded living here...along with my pocket book.

Phil Minkin 5 months, 3 weeks ago

This delay in caused by the same people who complained the loudest about the early implementation of the ACA. They can't handle a few people on a small state level, but were quite vocal in criticizing a huge national effort.

Bob Forer 5 months, 3 weeks ago

The callous and indifferent attitude of the Brownback administration towards our fellow human beings who are suffering and in need is absolutely disgusting.

My differences with the so-called Christian Conservaties go far beyond difference in opinion. They are utterly contemptible scoundrels.

Zachariah Davis 5 months, 3 weeks ago

I have a mental illness and am on medicaid and have been following the status of this for about a year. The problem with this is two fold.

First this is a whole team of healthcare providers so lets say I get my psych services from Bert Nash and then see a Private Physician not affiliated with Heartland or LMH under this plan I can't choose one or the other it limits the clients choice in providers.

Second: This is the second delay in the roll out of this service and as a consumer ZERO outreach has been done to inform me I get mailings all the time from my MCO to get a flu shot exc but nothing has been sent on this EVERYTHING I have learned is listed on the KanCare website that I was given a link to from an old coworker that I did advocacy with. I have the ability to understand and look up the info and news but many other SPMI (Severe and Persestant Mental Illness ie the ones that make employment and the such nearly impossible) clients don't have the ability to sort through all the Red Tape or even understand what it means. There is a choice to opt out but with the constant delays and from experience the lack of transparency on how to access different services or even what the consumers rights are I am afraid I will get stuck in this B.S. with no way to opt out

Third The mentally ill are a horrible group to choose to be the guinea pigs for this because if we want to admit it or not delays in service delivery and hindrances in the care provided can cause this illness to become lack of a better term terminal and whom will be carrying that blood on their hands.

The suicide rate went up 31.5 percent in one year after Brownback's first overhaul to the mental health system happened in 2012 http://www.kstatecollegian.com/2013/10/29/kansas-suicide-rate-increases-by-more-than-30-percent-funding-for-mental-health-centers-decreases/

Jon Stewart 5 months, 3 weeks ago

Zach, as a health care consumer, you've been paying close attention to this situation which is to be applauded. Although it is an elegantly simple concept that will be enormously helpful to thousands of local health care recipients, the idea is new and the terminology is slippery. Health Home services described in the article simply mean six core Case Management services that will help patient/clients navigate the system and get the proper care they need.

You are partially correct that this is the second postponement of the provision of these services. KDHE had originally targeted January 2014 for this rollout. As the article states, however, if you qualify for the program as someone with SMI, you will be contacted by your KanCare company followed by your Health Home provider, Bert Nash locally for SMI, as planned for the currently scheduled July 1 rollout.

However, the current postponement of these services don't involve those with SMI, only those with Chronic Conditions (diabetes and asthma). These same core Case Management services for those with Chronic Conditions will be offered through Heartland and it is these Case Management services targeting only those with Chronic Conditions that will be postponed.

I'd also like to point out that if you choose to avail yourself of these Health Home (Case Management) services, all other care that you receive can remain exactly the same if you choose. It simply means that the core Case Management services will come from Bert Nash or Heartland.

Richard Heckler 5 months, 3 weeks ago

Why was there any reason to reinvent the wheel? It is a costly endeavor.

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