Topeka 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."