Topeka Some members of a legislative oversight committee urged the Brownback-Colyer administration on Tuesday to hold off on launching a new version of the state's privatized Medicaid program known as KanCare so the public can have more input into the new system.
The administration is currently in the process of applying for a federal waiver to launch what it is calling "KanCare 2.0," which would take effect in January 2019, just as a new administration will be coming into office.
Among other things, the administration is proposing to impose work requirements and lifetime eligibility caps on some individuals.
But several people representing groups that work with KanCare and its members argued that those changes could do more harm than good and that the administration is moving ahead too quickly in the change.
Sean Gatewood, a former legislator who now lobbies for the KanCare Advocates Network, urged the committee to recommend that the transition be delayed another year, to 2020.
"The KanCare 2.0 application fails to lay out a detailed plan for the new program," he said. "It lacks financial estimates, and without those, particularly given the state's financial position, we don't have a complete picture of what's to come."
The Brownback administration established KanCare in 2013, handing over the administration of a Medicaid program to three for-profit insurance companies that are now paid a flat per-patient rate to manage the care of more than 400,000 people enrolled in Medicaid and the Children's Health Insurance Program, or CHIP.
Gatewood was one of more than 30 people who testified in person during the KanCare oversight panel's quarterly meeting.
Much of the testimony was a repeat of what the committee hears on a regular basis, including complaints about paperwork backlogs, cutbacks in services and delays in processing applications.
But much of it also focused on the KanCare 2.0 proposal, which many people said would be a step backward.
"We believe that many of the changes proposed in KanCare 2.0 would adversely affect a large number of KanCare recipients," said Judy Bellome of AARP Kansas. "If implemented, the waiver would likely worsen health outcomes, create significant financial hardship for many KanCare members in need of coverage, increase administrative costs to the state and result in increased uncompensated care costs for Kansas health providers."
The committee is expected to vote Wednesday on what recommendations to make to the full Legislature when it convenes in January. But some on the panel, particularly Democrats, urged the administration to delay KanCare 2.0, particularly after hearing the state's new interim Medicaid director Jon Hamdorf say that he is new to the job and doesn't yet have a "detailed operational understanding" of how the Medicaid program is administered.
"Don't take this personal, but it's very frustrating," said Rep. Jim Ward, D-Wichita, the House minority leader and a candidate for governor. "You've got a timeline that says you're sending this in by the end of the year and, while you're a very personable individual, do not have much depth about this program and the effect it's going to have on the people represented here."
Hamdorf, a former researcher at the nonpartisan Kansas Health Institute, replied, saying that even though the Kansas Department of Health and Environment, which runs the Medicaid program, is submitting the application soon, there will still be time to make changes in the program before it goes into effect in 2019.
"Just because we're submitting it doesn't mean it's finalized," he said. "
Meanwhile, Sen. Laura Kelly, D-Topeka, said she is skeptical that the work requirement would result in more employment and better health outcomes.
Rep. Barbara Ballard, D-Lawrence, said the message she heard from the testimony was that most people haven't had enough time to understand all of the changes the administration is proposing.
"It was a lot of concern about 2.0 when it's not defined how it's going to be different from 1.0," she said in an interview during a break in the meeting. "It was a combination of 'we know we have to continue it for the continuity, but have you really thought it through?' I don't know what's happening with seniors."
There was also testimony from people expressing concern that Congress has not yet reauthorized the Children's Health Insurance Program, or CHIP, which covers about 37,000 children in lower-income households.
Hamdorf told the committee that the Kansas CHIP program has enough funding to continue until March and that he is optimistic Congress will eventually reach agreement on how to fund it.
If it doesn't, however, he said it would cost the state about $38 million to continue insuring those children through the end of this fiscal year, June 30, and another $53 million next fiscal year.