Can Kansas really get better Medicaid results at lower cost?
The Kansas City Star
This could easily be a column about “Kan-Scare,” rather than KanCare because there are so many uncertainties about a sweeping reform program in Kansas that starts Jan.1, 2013, pending final federal approval, that folks could rightly be very concerned about their future medical care.
On that date, Medicaid — medical care for the poor — will cease to exist in Kansas. In its place, the 350,000 Kansans — adults, children, elderly and the disabled — now served by Medicaid will become a part of a private, managed care program called KanCare.
Medicaid in Kansas has been a $3 billion outlay in state and federal funds. But by putting everything into private hands, the Brownback administration is claiming they will reduce expenditures by almost $1 billion over the next five years.
Just how those savings will occur is the big mystery. KanCare was concocted, according to The Wichita Eagle, “behind closed doors.”
It is undeniable Kansas Medicaid costs have been increasing at an unsustainable rate of 7.4 percent per year, way over the inflation rate. So, something dramatic had to happen.
And dramatic things will happen. You don’t cut the budget that much without experiencing some major upheaval.
According to Brownback’s administration, KanCare’s chief aim is to curb growth while improving outcomes.
Are both possible?
According to the proponents of KanCare, one of the primary targets for cost savings will be reducing the numbers of poor residing in nursing homes. The new managed care companies will be taking a hard look at “necessities” of health care, and one conclusion already reached is that the elderly poor can be treated far less expensively at home.
But whether the outcomes will improve remain to be seen.
Where else will the three selected managed care providers — Amerigroup, UnitedHealthcare, and Sunflower State Health Plan — clamp down?
There is concern that cuts could come to the severely mentally ill who are expensive to take care of.
The developmentally disabled, after loud protests, are excluded from KanCare, but that decision was only postponed for one year.
Taxpayers may want to know how much in administrative costs will these companies rake off the top?
The Johnson County Board of County Commissioners is curious and has asked the state to provide them with the financial proposals of the three managed care organizations. They were told they had to request this information through the Kansas Open Records Act but were also told certain financial information would remain confidential.
Nowhere are the financial proposals posted on any website for the public. County commissioners were told that all parts of the contracts would be made public after the contracts were signed. Reportedly, the contracts have been signed, but information about administrative fees and other financial payments to the managed care organizations have not been made public.
Kansas is not the first state to switch to a managed care program, although according to the Kansas Health Institute, Kansas would be the only state where managed care companies provide care statewide to all Medicaid enrollees.
All three providers will be headquartered in Johnson County and will be hiring 750 employees. And, from what is expected, they will be paying very high prices for their workers. Already, one key employee at the Johnson County Mental Health Center was offered a reported $100,000 raise to move — and that employee did. Caseworkers making $35,000 a year are being offered up to $60,000 a year to move. And they will.
So, KanCare, while slashing costs in its services, is apparently paying its staff handsomely.
Are they paying management lavishly? That is a missing piece of the puzzle that we have a right to know. So far, the state has kept that confidential.
And, above all, what will be the fallout on KanCare patients when a billion dollars is cut from current services?
To reach Steve Rose, a Johnson County columnist, send email to email@example.com