Officials in Gov. Sam Brownback’s administration fired back Thursday at former Gov. Kathleen Sebelius over comments she made about Medicaid expansion, accusing Sebelius of having created the so-called “waiting lists” for elderly and disabled services in the first place. This all started a few days ago when Melika Willoughby, a young deputy communications director in Brownback’s office, sent out an email to political supporters, asserting that expanding Medicaid, as allowed under the Affordable Care Act, aaka “Obamacare,” would be “morally reprehensible” because it would prioritize able-bodied, childless adults over the frail elderly and disabled who are already on waiting lists to receive services. That led to Sebelius’ comment to the Journal-World Wednesday. Sebelius, one of the architects of Obamacare and the person largely responsible for implementing it during its first couple of years, called that statement “flat-out wrong” and said the only reason there are waiting lists is because the Brownback administration has underfunded the program. That, then, prompted Kansas Department for Aging and Disability Services spokeswoman Angela de Rocha to fire back late Thursday, calling Sebelius’ comments “wildly inaccurate.” “The Governor and the Legislature have made significant investments in increased funding to provide services to people with disabilities by investing in bringing people off waiting lists and into services, more than $65 million to date,” she said. In addition, she accused the Sebelius administration of creating the waiting lists in the first place when, in 2008 and 2009, in response to collapsing state revenues amid the global financial crisis, it implemented rule changes that reduced the number of people who received what are called “Home and Community Based Services.” This escalating war of words between the Republican and Democratic camps gives some indication of how heated this issue is likely to be in the next session, not to mention the 2016 elections. And so it merits some background and explanation.
First, what are the “waiting lists” for elderly and disabled services? Under Medicaid, low-income elderly and disabled individuals who can no longer take care of themselves are entitled to receive care in nursing homes. The problem is, that’s very expensive and, in many cases, unnecessary if the individual could only need a little help around the house. So in the 1990s, the states and the federal government started devising “waiver” programs to provide what are called “Home and Community Based Services,” or HCBS. It’s a waiver from the general rule that says the care has to be provided in a nursing home. Under the waiver, Medicaid will pay for medical care as well as certain nonmedical services such as house cleaning, home health aides, personal care, adult day health services, etc., so the individual can continue living at home. Kansas currently has six different types of HCBS waiver programs. They apply to the frail elderly; developmentally disabled; physically disabled; autism patients; traumatic brain injury patients; and those who need technology assistance. HCBS programs are cheaper for everyone because the government isn’t paying the cost of the physical plant of a nursing home. The individual lives in his or her own home. They’re also considered to be better, more humane forms of care because they leave individuals with a degree of independence and self-determination. The problem is, they’re not an entitlement the way nursing home care is. States have to budget for HCBS programs, and the federal government will kick in whatever its matching share is. (In Kansas, it’s about 55 percent of the total cost). But the number of people who get served is essentially capped by how much the state agrees to kick in. Since the inception of the program during Republican Gov. Bill Graves’ administration, the demand for HCBS programs has almost always outstripped the available funding. And, so, people are put on waiting lists.
How would expanding Medicaid affect the elderly and disabled who are on waiting lists? Sebelius’ argument is that it wouldn’t. They’re completely different programs. The frail elderly and disabled individuals who may qualify for HCBS plans are still entitled to medical care through nursing homes. And the state would still be in control over how much it spends for home and community-based care. The expansion of Medicaid to cover all individuals in households up to 138 percent of the poverty level is entirely separate. And, for the first three years, it would be 100 percent funded by the federal government. That gradually scales down to 90 percent in a few years, but Sebelius still calls it the most generous federal-state cost sharing program in U.S. history. Brownback, however, counters that as a practical matter, one does affect the other because the state has limited resources. Eventually, the state will have to pick up some share of the Medicaid expansion cost. And he says it’s unfair to add that cost onto the Medicaid system for able-bodied, working-age adults when the state is struggling to serve all of the elderly and disabled people who want HCBS plans. Sebelius’ counterargument to that is, it doesn’t have to be an either-or proposition. States can and — in her view, at least — should do both.
A new poll shows the race for Kansas governor remains tight.
The poll showed Democrat Paul Davis of Lawrence leading Republican Gov. Sam Brownback 45 percent to 41 percent, with 14 percent unsure. The poll's margin of error was plus or minus 3.3 percentage points. It was conducted April 1-3, before the contentious last weekend of the legislative session.
The poll, commissioned by the left-leaning MoveOn.org's political action committee, also shows that 52 percent of Kansans want the state to accept federal funding to expand Medicaid coverage while 35 percent oppose it and 13 percent are unsure.
Under the Affordable Care Act, states can increase income eligibility to allow more people to receive health care coverage under Medicaid.
Medicaid provides coverage for the needy and disabled. Under the ACA, federal funds would pay 100 percent of the cost of expansion for three years and no less than 90 percent after that.
Supporters of expansion of Medicaid say it would help thousands of Kansans who earn too much to be eligible for Medicaid or to receive premium tax credit assistance under the ACA to purchase private insurance.
There are 182,000 Kansans within that gap, according to a study by the Kansas Health Institute. Of that number, 78,400 have no insurance, the study said.
Brownback and the Republican-led Kansas Legislature have refused to expand coverage. Brownback has said he fears the federal government won't keep its funding promise.
A bill approved by the Legislature and awaiting consideration by Brownback would ban indefinitely expansion of Medicaid.
According to the new poll, when told that Davis wants to expand Medicaid, 39 percent of those polled said that made them more likely to vote for him, while 34 percent said less likely.
When told that Brownback opposes expansion of Medicaid, 33 percent said that made them more likely to vote for him while 41 percent said that it made them less likely.
The poll, conducted by Public Policy Polling surveyed 886 likely voters in Kansas. Fifty-two percent of those polled identified themselves as Republican, 30 percent Democrat, and 18 percent independent.
Topeka — Is Gov. Sam Brownback moving closer to siding with expansion of Medicaid under the federal Affordable Care Act?
In a two-minute question and answer session with reporters, Brownback, a Republican who opposes the ACA, said his administration is looking at options and alternatives.
"We're still working on Medicaid, what we can do that we could make it work," he said.
Brownback then talked about wanting to make sure the state budget was in good shape and that when he took office in 2011, he was facing a shortfall "after the Sebelius administration."
Former Gov. Kathleen Sebelius, a Democrat, left Kansas to become President Barack Obama's secretary of the U.S. Department of Health and Human Services. Sebelius was succeeded by Mark Parkinson, the former lieutenant governor, who had to deal with record revenue shortfalls during the Great Recession. Ironically, it's Sebelius, as HHS secretary, who is working with governors considering Medicaid expansion.
While many Republican governors, including Brownback, have been critical of Medicaid expansion, some are warming to the idea since the federal government will pay for the first three years, and 90 percent of it after that. Some have also said that it would be unwise for a state to leave federal money on the table for other states to take.
Missouri Gov. Jay Nixon, a Democrat, has been trying to persuade Republican legislative leaders to get on board. Earlier this week, Nixon said that if Missouri were to reject expansion of Medicaid it would become like a town from the 1860s that refused a railroad or a city from the 1960s that rejected an interstate highway. In Kansas, estimates indicate that Medicaid expansion would extend coverage to 200,000 more people.
Currently, Medicaid provides health care coverage to about 380,000 Kansans. The largest portion of them — about 230,000 — are children. The rest are mostly lower-income, pregnant women, people with disabilities and elderly people. The $2.8 billion program is funded with federal and state dollars.
Medicaid in Kansas doesn’t cover low-income adults who don’t have children. And a nondisabled adult with children is eligible only if his or her income is below 32 percent of the poverty level, which is less than $6,000 per year. That is about the most difficult eligibility level in the country.
But starting in 2014, the ACA creates an eligibility level of 138 percent of the federal poverty level, which is $15,415 per year for an individual and $31,000 per year for a family of four.
In the Legislature, Senate President Susan Wagle, R-Wichita, has been open to the idea of expanding Medicaid, while House Speaker Ray Merrick, R-Stilwell, hasn't.
Topeka — In Kansas, Gov. Sam Brownback and his conservative Republican colleagues in the Legislature seem to be following the no-way, no-how lead of Texas Gov. Rick Perry on whether to expand Medicaid under the federal Affordable Care Act.
But this story link text in the San Antonio Express-News shows that not all is as it appears in Texas.
While Perry, whom Brownback backed for the Republican nomination for president, is taking a tough-guy stand against Medicaid expansion, key legislators in the Lone Star State are working behind the scenes for a "Texas solution."
And there may be more acceptance in conservative Republican circles for a proposal by Arkansas that has apparently gotten the green light form Health and Human Services Secretary Kathleen Sebelius, a former Kansas governor. This bloglink text reports that Sebelius has said OK to the plan to use Medicaid dollars to buy private insurance.
So far, Brownback says he is undecided on whether to opt in to expanding Medicaid in Kansas, although whenever asked he says he worries about the costs and notes the state's budget problems — problems caused by income tax cuts he signed into law last year.
And conservative Republicans in the Legislature are pushing a resolution opposing the expansion of Medicaid. Hospitals and health care groups oppose the resolution. In addition, a statewide poll conducted on behalf of the Kansas Hospital Association found that 60 percent of Kansans support expanding Medicaid.
Under the Affordable Care Act, the federal government would pay the entire cost of the expansion for three years, and then that share would fall down to 90 percent after that.
Currently, Medicaid provides health care coverage to about 380,000 Kansans. The largest portion of them, about 230,000, are children. The rest are mostly lower-income, pregnant women, people with disabilities and elderly people. The $2.8 billion program is funded with federal and state dollars.
Medicaid in Kansas doesn’t cover low-income adults who don’t have children. And a nondisabled adult with children is eligible only if his or her income is below 32 percent of the poverty level, which is approximately $5,000 per year. That is about the most difficult eligibility level in the country.
But starting in 2014, the ACA creates an eligibility level of 138 percent of the federal poverty level, which is $15,415 per year for an individual and $26,344 per year for a family of three.
Estimates are that expansion would cover upwards of 150,000 more Kansans.
Brownback remains undecided on Medicaid expansion; supports adult stem cell center; declines to state position on drug testing welfare recipients and relaxing renewable energy standards
Topeka — Gov. Sam Brownback on Wednesday said he hasn't made up his mind on whether Kansas should opt in to a federally funded expansion of Medicaid, but he expressed concerns about the future flow of dollars to the state from Washington, D.C.
In a brief question and answer period with reporters as the 2013 legislative session neared the midway point, Brownback said he was still analyzing data on Medicaid expansion but added that he is worried about future costs.
"We have a lot of pressures on the state budget that are significant," he said. He mentioned a court order to increase school funding, an at-capacity prison system and what he described as high demand for spending on public universities.
In addition, Brownback predicted that federal funding to the state in general would decrease over the next decade because of federal budget difficulties.
Under the Affordable Care Act, the feds would pay 100 percent of the Medicaid expansion costs for three years and then ratchet that down to 90 percent over the next several years.
On other issues, Brownback declined to state his position on bills that would relax renewable energy standards and require drug testing of some welfare beneficiaries.
"We'll see what gets to me," he said of a measure approved by a House committee to rollback the requirements for renewable energy.
On a bill approved by a Senate committee that would require drug tests for recipients of certain benefits, Brownback said, "Let's see what the Legislature puts forward on something like that."
Asked to comment on a Senate committee rejection of his reading initiative, he said he understood it was an emotional subject and that the discussion will continue. The Senate Education Committee defeated Brownback's proposal that would have required schools to hold back students in the third grade if they scored in the bottom performance level on the state's reading test.
On another issue, Brownback expressed support for establishing an adult stem cell center at Kansas University Medical Center.
"Having an adult stem cell center is not only highly plausible, it's being done and used in many places around the world," he said. "If Kansas could take a leadership position in that, it could be a highly useful thing for people to get treatments. There are number of different maladies now being treated by noncontroversial stem cell treatments," he said.
He added, "Let's see what develops in the process and in the bill." The bill would prohibit the center from using embryonic stem cells or cells taken from aborted fetal tissue.
Gov. Sam Brownback on Friday announced that federal officials have approved a waiver request to implement sweeping changes to the Kansas Medicaid system.
Kansas has already awarded three contracts to managed care organizations to run the Medicaid program, which provides health care coverage to 380,000 poor and disabled residents.
Known as KanCare, the Brownback administration has said the changes will help control care costs and improve care.
The new system will be in effect Jan. 1.
About 75 people on Friday gathered outside the Statehouse, calling for Gov. Sam Brownback to support an expansion of Medicaid, the state and federally funded program that covers the cost of health care services for nearly 400,000 Kansans, mostly children, pregnant women and those with disabilities.
Rev. Joshua Longbottom, of the Plymouth Congregational Church in Lawrence, was one of several speakers at the rally. He said Jesus would have supported the expansion.
"If Jesus was up in the Capitol, would he make a choice to keep 130,000 people without care," Longbottom asked. The crowd responded "No."
Under the Affordable Care Act, the state has the option to extend Medicaid coverage to include all children and adults under the age of 65 who live at or below 133 percent of the federal poverty level. For a family of four, that is an annual income of $30,657 or less. Extending the Medicaid program in 2014 could help provide access to as many as 130,000 more Kansans, according to the Kansas Health Consumer Coalition.
The federal government would cover of the cost of the Medicaid expansion for the first three years and most of the cost after that.
Republicans and some Democrats have expressed concerns that because of federal budget problems, the federal government may not be able to carry through with its funding commitment.
And Brownback has been an ardent opponent of the Affordable Care Act. Yesterday he announced he would block an effort by Kansas Insurance Commissioner Sandy Praeger for a state-federal partnership in starting a health insurance exchange under the ACA. That means the federal government will have to do it.
Douglas County has sometimes been called an island of blue in a sea or red in Kansas, meaning it votes Democratic while most of the rest of the state votes Republican.
But the blue dot becomes even more noticeable in the Midwest when looking at a national map of county results. There is blue Douglas and Wyandotte, which went for President Barack Obama.
And then there is a sea of red — counties where Republican Mitt Romney secured a majority of votes — that includes all of Oklahoma, all of Nebraska, except for one county, and all of Missouri, except for three counties. Farther south, Texas is mostly red until Dallas County and Travis County and then a belt of blue in South Texas.
Here is a link to the New York Times presidential election map by counties. link text
In a split vote along party lines, a legislative committee on Thursday rejected pleas from advocates for the elderly and those with disabilities for a delay in implementation of Gov. Sam Brownback's plan to privatize the Medicaid program, which serves nearly 400,000 Kansans.
State Rep. Barbara Ballard, D-Lawrence, sought to delay the proposed Jan.1 startup of KanCare by six months to July 1. "I'm still not convinced that they are ready," Ballard said.
But Republicans on the committee said the state has devoted a lot of time and effort to starting KanCare on Jan. 1 and pushing that back would cause confusion.
"To move that date now would be very inappropriate," said state Rep. David Crum, R-Augusta, who is chairman of the House-Senate Committee on Home and Community Based Services.
Ballard's motion to delay implementation failed 2-3. Joining Ballard was state Rep. Jerry Henry, D-Cummings. Voting against Ballard's motion were Crum, state Sen. Carolyn McGinn, R-Sedgwick, and state Rep. Peggy Mast, R-Emporia.
Under KanCare, the state's current Medicaid system will be switched over to three managed care plans run by private insurance companies. Medicaid is a nearly $3 billion per year state and federally funded program that provides health care to poor and disabled Kansans. The changes must be approved by the federal Centers for Medicare and Medicaid Services before it can be implemented, and the Brownback administration has been shooting for Jan. 1 approval.
Earlier Thursday, advocates for those with disabilities, children and the elderly said that the switchover in 54 days was too fast.
"We believe such an aggressive timeline, with little oversight, for an untested system will place many of the state's frailest and most vulnerable residents into a long-term managed care program that we believe the state is not ready to operate," said David Wilson, the immediate past president and current lead volunteer for AARP Kansas.
Tom Laing, executive director of InterHab, which advocates for those with disabilities, said "We are deeply concerned over the evident lack of preparations to oversee a program of such magnitude."
But Kari Bruffett, director of the Health Care Finance Division of the Kansas Department of Health and Environment, said the state was on track.
Bruffett said state officials had "positive and productive meetings with CMS officials" on Oct. 18.
And she said the managed care organizations were ready to deliver Medicaid services.
The Brownback administration has said KanCare will improve health outcomes while saving the state money.