Wednesday, December 11, 2013

Kansas poised to turn over DD services to for-profit health plans

This is from an article in Kaiser Health News posted on 12/5/13 called  "In Kansas, A Fight Over Developmentally Disabled Shifting To Medicaid Managed Care" by Jenni Bergal. According to the article, Kansas is poised to hand over all home and community-based services for 8,500 people with developmental disabilities to three for-profit Medicaid managed health plans on January 1, 2014:

"…What concerns families and advocates the most is that the three for-profit national insurance companies that run KanCare [the program through which the State of Kansas administers Medicaid] will be responsible for a statewide program that they’ve never managed in Kansas or elsewhere. They’re also worried that the need to make a profit ultimately will destroy a system families and advocates think works well.

"While Kansas will become the first state to make such a leap, it is being watched closely elsewhere, as at least two other states – Louisiana and New Hampshire – are considering moving in the same direction.

“'This is an unprecedented model. No state has ever taken a developmental disability population and placed it in an arrangement like this, with an out-of-state managed care system, all at once,' said Rocky Nichols, executive director of the Disability Rights Center of Kansas, a legal advocacy group. 'It’s almost like throwing everyone into the deep end of the pool.'"

Families believe the current system is working well and wonder why the state would take such risks with their DD family members:

"In Kansas, where a network of community-based nonprofit organizations and county agencies oversee these services, individuals can choose a case manager, who visits them at home and coordinates their care. In some cases, those relationships go back decades. While these organizations will continue to determine what services clients are eligible for and case managers will work with families to arrange that care, ultimately the health plans will be responsible.

“'There is a great deal of fear in the community that these big private health plans don’t know much about this population,' said Maureen Fitzgerald, disability rights director for The Arc, a national advocacy organization for the developmentally disabled. 'These are such vulnerable people. Mistakes that are just inconvenient to some can be devastating to them. If the home care person doesn’t show up, you could be lying in your bed all day. It’s kind of scary.'

"Only a handful of states, including Michigan and Vermont, have moved the developmentally disabled into managed care for long-term services. They’ve mostly relied on existing networks of community-based nonprofits or county agencies or have made themselves the managed care organization. None has turned exclusively to national managed care companies."

The health plans currently manage the medical care for people with developmental disabilities, but not the non-medical care and social services that so many rely on.

The article continues:

"[Governor] Brownback, a Republican, has said that KanCare will improve care coordination and reduce growth in Medicaid spending for the state and federal government by $1 billion over five years.

"Although the frail elderly, physically disabled and mentally ill are now getting long-term services through KanCare, inclusion of the developmentally disabled was delayed until 2014 by the legislature following bitter protests from parents, advocates and providers. Lawmakers wouldn’t yield again, even as more than 1,000 people rallied outside the Capitol in Topeka in May, many wearing red T-shirts that read: 'Not Worth the Gamble.'"

The state says that nervous providers have gotten families unnecessarily riled up about the plan, and has assured them that services won't be cut. 

"…But many are skeptical. They fear that the managed care companies will seek to boost profits by reducing services or driving some small providers out of business because of payment delays or denials. The companies say these concerns are unfounded and insist that services will be maintained and providers paid promptly."

This is certainly a situation that warrants watching. Kansas is going to turn over the management of home and community-based services for people with developmental disabilities to for-profit health plans that have no experience serving this population but are very good at making money. What could possibly go wrong?

Kaiser Health News (KHN) is a nonprofit news organization committed to in-depth coverage of health care policy and politics.