Does KanCare work? The state’s data is so bad, legislative auditors can’t tell

Source: Andy Marso, Kansas City Star, May 9, 2018
 
A debate has raged in Kansas for years over KanCare, the privatized Medicaid plan enacted by Sam Brownback in 2013. Brownback and his successor, Jeff Colyer, have touted the program as a tremendous success that has saved the state $1 billion while improving care for 400,000 low-income and disabled Kansans. Democrats, provider groups and people who care for disabled Kansans have said it’s rife with billing problems, secrecy and decisions based more on money than quality care. … After a year of work, those auditors recently released their determination: the state’s data is so bad, there’s no way to know. “These data issues limited our ability to conclude with certainty on KanCare’s effect on service use and limited our ability to interpret cost trends,” the auditors wrote. “More significantly, data reliability issues entirely prevented us from evaluating KanCare’s effect on beneficiaries’ health outcomes.” …

Related:

Kansas lawmakers dispute over possible passing of current KanCare 2.0 plan
Source: Kate Inman, Four States, April 23, 2018
 
Some Kansas lawmakers say they’re frustrated the state could move forward with the current version of KanCare 2.0.  The KanCare Oversight Committee heard more than five hours of testimony today from dozens of groups and people calling on the state to not move forward with KanCare 2.0. KanCare is the state’s privatized medicaid program.   During the committee meeting, some lawmakers wanted to revoke the panel’s previous support for Governor Colyer’s plan for KanCare 2.0. Under his plan, the state would implement work requirements and other eligibility rules.  The committee chairman says there isn’t enough time for lawmakers to recommend changes to KanCare 2.0 while others say it’s their job. …

Kansas gives Medicaid contractor until June 1 to improve
Source: Associated Press, February 17, 2018
 
The company processing Medicaid applications in Kansas faces fines of up to $250,000 a day and the loss of its state contract because it is far out of compliance with the required performance standards.  The Wichita Eagle reports that state sent Maximus a noncompliance letter Jan. 30 that gives the Virginia-based company until June 1 to fix problems that include only 40 percent accuracy on financial payments. State Medicaid Director Jon Hamdorf disclosed the action during a meeting of a legislative oversight committee Friday.  If the company fails to shape up, it could face fines retroactive to the beginning of the year, possibly totaling tens of millions of dollars. …


Hospitals slam Kansas’ proposed Medicaid overhaul
Source: Virgil Dickson, Modern Healthcare, January 3, 2018
 
Providers are concerned that a new waiver to overhaul Kansas’ Medicaid program will impede access to care and further empower managed-care plans, which they claim lack proper oversight.   For years, Kansas providers have complained the state’s Medicaid program, known as KanCare, was complex to work under and that it underpaid or didn’t pay at all for services.  Rather than revamp KanCare’s oversight of the plans, Republican Gov. Sam Brownback submitted a waiver late last month that appears to cede additional power to them, providers said. …

Legislative Panel Backs KanCare Renewal Plan, But Opponents Hope To Block Implementation
Source: Jim Mclean, KCUR, December 1, 2017

Republican legislators have temporarily sidetracked an effort to block the Brownback administration from obtaining federal approval to renew KanCare, the state’s privatized Medicaid program. Democrats on a joint committee that oversees KanCare wanted the panel’s report to the full Legislature to recommend keeping the current program in place until a newly elected governor takes office in January 2019. … In addition to the timing issue, advocates and some lawmakers are concerned about several provisions in the administration’s KanCare 2.0 plan, including work requirements and lifetime caps on services for some beneficiaries. …

GOP candidates fight over health program serving 400,000 Kansans
Source: Jonathan Shorman, Wichita Eagle, November 26, 2017
 
A fight between the Republican candidates for governor over the state’s privatized Medicaid program could shape what happens to the health care of more than 400,000 Kansans.  The next governor could abandon a proposed work requirement for some recipients of KanCare, which serves people who are poor, elderly or have disabilities. Or he could pursue Medicaid expansion.  Lt. Gov. Jeff Colyer, who is preparing to become governor, spearheaded the creation of KanCare in 2013. Some of his opponents say the current administration, including Colyer, has poorly run the program. …

KanCare Concerns A Challenge For Officials Seeking To Renew Privatized Medicaid Plan
Source: Jim McLean, KCUR, November 20, 2017
 
Kansas officials seeking to renew KanCare are asking people covered by the privatized Medicaid program to trust them to make it better.  In a series of recent public hearings, state officials have assured providers and beneficiaries that KanCare 2.0 will fix the administrative and service-delivery problems that have plagued the current program since its inception. … Since 2013, three for-profit companies known as managed care organizations have administered KanCare, which provides health insurance to more than 420,000 low-income, disabled and elderly Kansans. Though many states have contracted with MCOs to run their Medicaid programs, Kansas was the first to privatize services for people with disabilities.  The move to privatization prompted immediate complaints from providers and recipients alike about increased red tape and reductions in services. Those complaints have subsided in recent years but haven’t stopped. …

Caregivers of disabled left in dark under Kansas’ private healthcare system
Source: Andy Marso, Kansas City Star, November 12, 2017

… The Star found other caregivers who were asked to sign off on plans of care without knowing if they included cuts — one of several concerns about transparency that have arisen since the state became the first in the country to privatize its entire Medicaid program by establishing KanCare in 2013. KanCare has made the Medicaid system in Kansas less collaborative and more secretive for people with disabilities, a group of independent case managers from Johnson County said in an August interview with The Star. When the system was run by the state and a network of disability non-profits, the case managers said, the focus was on figuring out what services could help and how to find them. Now it’s about justifying the services they’re getting. …

Kansas proposes Medicaid work requirement
Source: Jonathan Shorman, Kansas City Star, October 27, 2017

The next version of Kansas’ privatized Medicaid program will require about 12,000 adults to work, a stipulation no state’s program currently includes. State officials unveiled their proposal for KanCare 2.0 on Friday. The program serves more than 400,000 residents but right now has no work requirement. The federal government must approve the proposal before implementation, a process expected to take months. …

Federal health officials approve one-year extension previously denied to KanCare program
Source: Allison Kite, Topeka Capital-Journal, October 17, 2017

The federal government has granted a one-year extension of Kansas’ privatized Medicaid program after denying the request and citing deficiencies in the program earlier this year. Following an on-site visit a year ago, the Centers for Medicare and Medicaid Services in January denied Kansas’ request for an extension and cited several concerns about the way the state ran its Medicaid program, KanCare, including limited oversight and coordination it argued posed a risk to recipients. The Kansas Department for Health and Environment, which runs KanCare with the Kansas Department for Aging and Disability Services, took issue with the January findings. In a letter dated Friday, CMS approved the request to extend the program through next year, as long as the state follows a list of directives, including continued compliance with a corrective action plan it submitted following the denial. The letter says the state has to apply for its full five-year reapplication by the end of the year. …

Study finds shortfalls in KanCare coverage for mental illnesses
Source: Allison Kite, The Topeka Capital-Journal, September 24, 2017

A new analysis of the state’s Medicaid program, KanCare, found recipients with mental illnesses often face barriers to getting the care they need, and it served as confirmation to some health advocates who have previously raised issues about the program. … The study found KanCare recipients with serious mental illnesses had a hard time getting information about their coverage, acquiring needed medications and finding some providers, especially specialists. Hall said fewer than 20 percent of the 189 recipients she and her co-authors surveyed had spoken with a care coordinator, someone designated to help individuals covered by KanCare organize appointments and access care. For some health advocates, that critique echoed concerns they have heard since the state rolled out KanCare in 2013. …

Read full report.

Fact Meter: Kansas budget director’s chart offers misleading view of KanCare waiting list
Source: Tim Carpenter, Topeka Capital-Journal, August 28, 2017

The fate of thousands of Kansans with intellectual or developmental disabilities who don’t receive benefits for which they’re qualified remains a contentious issue more than four years into operation of the state’s privatized $3 billion Medicaid system. Shawn Sullivan, budget director for Gov. Sam Brownback, discussed during a presentation to a House and Senate oversight committee the need for sustained state government revenue growth to shrink the waiting list for home- or community-based services through Medicaid. …

Kansans share KanCare concerns with legislative panel
Source: Tim Carpenter, Topeka Capital-Journal, August 22, 2017

Individuals and associations representing enrollees in Kansas’ Medicaid program shared frustration Monday with difficulty securing services for thousands of people eligible for assistance as well as with Gov. Sam Brownback’s declaration of policy victory for saving the state treasury $1.4 billion after turning the system over to three insurance companies. … Dozens of issues were raised at the Capitol during a hearing of the Kansas Legislature’s joint committee on KanCare oversight. Testimony in support of the KanCare insurance providers and state agencies blended with complaints raised repeatedly over the years. This inquiry by legislators occurs at a time of transition, with Brownback preparing to leave office and the state applying to the federal government for permission to continue with KanCare, which serves more than 400,000 low-income adults, pregnant women and people with disabilities. …

Feds stop requiring bi-weekly Kansas reports on Medicaid
Source: Associated Press, July 12, 2017
 
Federal officials are no longer requiring Kansas to file bi-weekly reports on a large backlog of applicants for the state’s privatized Medicaid program.  The Kansas Department of Health and Environment was notified last week by the Centers for Medicare and Medicaid that the state can discontinue the reports it has been sending since early 2006. At the time, Kansas had more than 7,000 backlogged applications that had been pending for more than 45 days for its Medicaid program, called KanCare. …

Kansas House fails to override Brownback Medicaid expansion veto
Source: Hunter Woodall, Kansas City Star, April 3, 2017
 
The Kansas House failed by a narrow margin Monday to override Gov. Sam Brownback’s veto of a bill that would expand Medicaid to thousands of low-income Kansans.  Lawmakers voted 81-44 to override the governor’s veto, three shy of the total needed to pass the bill without his support.  That effectively ends the Medicaid expansion push in Kansas after it passed out of both chambers with Republican and Democratic support earlier this year. … The legislation vetoed by Brownback would have expanded KanCare, the state’s privatized Medicaid program, to roughly 150,000 people in the state. …

Brownback Vetoes Medicaid Expansion in Kansas
Source: Russell Berman, The Atlantic, March 30, 2017

Governor Sam Brownback of Kansas on Thursday vetoed legislation expanding Medicaid passed with Republican majorities in the state’s House and Senate. Supporters of the bill are likely a few votes shy of the two-thirds majority needed to override Brownback’s veto. The move was expected, since Brownback has opposed expanding Medicaid for years. But the expansion effort could find new life if the governor leaves office before his term ends next year; President Trump is reportedly considering an appointment for Brownback as U.N. ambassador for food agriculture, a posting that would take the one-time presidential candidate from Topeka to Rome. …

Kansas’ privatized Medicaid program gets the federal brushoff, setting back health care in the state — again
Source: Barbara Shelley, The Pitch, January 24, 2017

Three years ago, Kansas Gov. Sam Brownback signed a scary piece of legislation known as a health-care compact. Pushed by Sen. Mary Pilcher-Cook of Shawnee and other fringy lawmakers, it was designed to allow Kansas to basically secede from federal health-care programs and do its own thing. … Enacting it requires a vote by Congress and a cooperative administration, elements that seemed farfetched in 2014 — when Democrats controlled the U.S. Senate and Barack Obama sat in the White House — but could now be on the horizon. At least eight other states, including Missouri, have passed health-care-compact legislation. But Kansas stands out as uniquely unqualified to run its own health care. Look no further than the revelation last week that the Centers for Medicare and Medicaid had rejected the administration’s request for a one-year extension of KanCare, the state’s privatized Medicaid program. In a letter, federal officials said they had substantiated multiple complaints from Kansans about ineptitude and denial of care on the part of the for-profit managed-care companies running the program. The state’s failure to demand accountability from the companies is endangering the health and life of citizens, especially those with disabilities, the letter said. …


Criticizing Kansas, feds deny extension of KanCare privatized Medicaid program
Source: Bryan Lowry and Hunter Woodall, The Kansas City Star, January 19, 2017

Federal officials have rejected Kansas’ request to extend the state’s privatized Medicaid program for another year after raising concerns about the program’s transparency and effectiveness. Kansas is “substantively out of compliance with Federal statutes and regulations, as well as its Medicaid State Plan,” concluded investigators from the Centers for Medicare and Medicaid Services after a review in October, according to a letter sent to state officials on Jan. 13. That federal agency oversees the program. Four days later, CMS rejected the state’s request to extend the program through December of 2018. Kansas’ authorization for its privatized system ends at the end of this year. The state must take corrective action to ensure the continued existence of KanCare and submit a plan to address federal officials’ concerns by Feb. 17. Kansas privatized its $3 billion Medicaid program in 2012 under the KanCare umbrella at Gov. Sam Brownback’s urging, shifting the bulk of responsibilities for providing services to three private managed care organizations. The program relies on a combination of state and federal funding. Federal investigators identified a series of shortcomings with the program’s administration, including diminished oversight by the state and a failure to provide beneficiaries with clear and consistent information. … Among other problems identified by CMS investigators: The state lacks a comprehensive system for reporting and tracking critical incidents for beneficiaries on the disability waiver, and no data exists to show unexpected deaths were investigated within required timeframes. …. The letter also faults the state for allowing the managed care organizations to develop their own appeals processes. Under federal rules, the state should have either developed or approved that process. … There’s a possibility that the new administration could be more lenient on Kansas, but Gatewood said this puts pressure on state policymakers to respond regardless. … The federal government spends $1.28 for every dollar the state spends on Medicaid. If Kansas fails to meet federal standards, it will put that money at risk.

Report questions health claims of Medicaid privatization in Kansas
Source: Tim Carpenter, Topeka Capital-Journal, November 17, 2016

Frustration among legislators and Medicaid service providers with management of Kansas’ privatized system resurfaced Thursday in conjunction with a consulting firm’s report asserting the overhaul failed to deliver on promises of improvement in quality of health care. The critique occurred as the administration of Gov. Sam Brownback faced a $350 million tax revenue shortfall in the current state budget and worked to develop new contracts with insurance companies running the $3 billion KanCare system serving 400,000 poor, disabled and elderly Kansans. Brownback and Lt. Gov. Jeff Colyer shared confidence four years ago an approach directed by the private sector would foster better medical outcomes. Colyer, a Johnson County surgeon, vowed reform would “provide our most vulnerable Kansans with superior service at a more sustainable price.” … Leavitt Partners produced the report by reviewing federal and state data and through interviews with KanCare providers at behest of the Kansas Medical Society, Kansas Association for the Medically Underserved and Kansas Hospital Association. Representatives of these three Kansas organizations joined with other health groups to outline for House and Senate members of the KanCare oversight committee their views on administration of privatized Medicaid in Kansas. Many of the complaints surfaced in previous legislative hearings. There was consensus the duplicative process of obtaining service-provider credentials from managed-care companies had to be standardized and centralized. In a strange twist, there was testimony KanCare providers encountered difficulty returning money to MCOs due to accidental overpayments while also enduring delays in receiving millions of dollars in appropriate compensation from those same companies. …

Kansans affected by privatization of Medicare eager to find forum, listening ears
Source: Tim Carpenter, Hutchinson News, August 25, 2016

Bronaugh said her son’s nursing-care hours were cut 40 percent at about the same time she raised questions about Sunflower’s noncompliance with contractual obligations. She shared documents showing Sunflower staff claimed she lied about her son’s disability to secure help he wasn’t eligible to receive. Bronaugh said the false allegations were an attempt to silence her and get her to drop an appeal of the nursing time. … Her feedback would have been the type likely to surface this week during a five-city listening tour that was to have provided Brownback officials insight into the governor’s 4 percent budget cut to some Medicaid providers on July 1. The $38 million was reallocated in an attempt to balance the state’s budget. Forums in Topeka, Overland Park, Wichita, Pittsburg and Dodge City were canceled to limit public disclosure of how Kansans viewed KanCare. The $3 billion system serves about 420,000 disabled, poor and elderly Kansas residents. Officials of the Kansas Department for Aging and Disability Services, as well as the Kansas Department of Health and Environment, acknowledged growing pains with KanCare, but told state lawmakers the collaboration with private industry ought to be viewed as a success. Bipartisan criticism of the Medicaid cut did lead Brownback to recommend restoration of funding through adoption of a special tax on hospitals. …

Kansas Providers Bristle, Brace for Medicaid Cuts
Source: John Commins, Health Leaders News, June 1, 2016

Kansas Gov. Sam Brownback’s $56 million cut to the privatized KanCare Medicaid program is facing blowback from healthcare providers. In a media release detailing the cuts, Brownback said KanCare’s 4% reductions to providers, which take effect on July 1, would exempt home- and community-based services and almost 100 hospitals defined as rural, densely settled rural, frontier and critical access hospitals. … In a sharply worded open letter last week, however, Kansas Hospital Association President and CEO Tom Bell threw the baloney flag and accused the governor of attempting to obfuscate the scope of the cuts, which were part of more than $80 million in reductions to the overall state budget. … More than 30 of the state’s 107 rural hospitals are in danger of closing, and Bell said the ongoing effect of the KanCare cuts has become “obvious.” … Kansas remains one of 19 holdout states that reject Medicaid expansion and the money that comes with it under the Affordable Care Act. As a result, Kansas has lost an estimated $1.2 billion in federal matching funds. Brownback privatized KanCare in 2013 with assurances that the leaner and more efficient program would improve access to care. So far, those promises have not materialized. Providers and patient advocates hate it, and commercial payers aren’t happy with it either. The Witchita Eagle reported last week that KanCare’s health plans, Sunflower, UnitedHealthcare and Amerigroup, reported losing $52 million in Kansas in 2014.

KanCare up for renewal despite performance shortfalls
Source: Gabriella Dunn, Wichita Eagle, May 26, 2016

The state will negotiate new contracts for its privatized Medicaid system that some describe as inefficient and ineffective. The contracts will take effect in 2018. … Sunflower, UnitedHealthcare and Amerigroup currently provide Medicaid plans in Kansas. It’s unclear if other insurance companies would be willing to offer plans in Kansas’ privatized system. The three companies reported losing $52 million in Kansas in 2014. To compound financial issues, Gov. Sam Brownback cut Medicaid reimbursements to providers by 4 percent to help fill the state’s budget hole. The cuts will go into effect in July but will exempt critical access hospitals in rural areas along with nursing homes and home- and community-based disability services. …

KanCare companies up for renewal; state to hold meetings
Source: Gabriella Dunn, The Wichita Eagle, May 12, 2016

The three privatized Medicaid companies in Kansas – Sunflower, UnitedHealthcare and Amerigroup – are due for contract renewals, but have been criticized for not meeting previously promised expectations. Medicaid recipients have reported longer wait times and more reimbursement denials since the privatization. And an inspector general position, which serves as a watchdog over the program, has been vacant since January 2014. …

Gov. Sam Brownback says privatized Medicaid is working in Kansas, but some patients and hospitals don’t see it
Source: Steve Vockrodt, The Pitch, January 19, 2016

While health-care providers tell The Pitch that KanCare works relatively well for patients who don’t rely on it daily, it has led to some struggles for people who require more intensive care. Some health-care providers say KanCare requires a quantity of paperwork that’s cumbersome even by insurance-company standards. They add that the system has routinely denied legitimate claims, forcing delays as hospitals and clinics file appeals. All of which belies the state’s claim that a privately managed Medicaid would streamline the bureaucracy inherent in a state-run program. … With this statement, Brownback made clear once again that he wants the Legislature to stay the course with KanCare and reject Medicaid expansion, which is an Easter egg for states to consider as part of the federal Affordable Care Act. Medicaid expansion is seen by its advocates as a way to provide more services to the most vulnerable in Kansas and, at least temporarily, give some relief to the financial millstone around the Kansas budget. …

Federal investigation of Kansas Medicaid waiting lists ongoing
Source: Andy Marso, Kansas Health Institute, July 22, 2015

A spokesman for the U.S. Department of Justice said Tuesday that the department is still investigating complaints about Medicaid waiting lists for disability services in Kansas. The services are daily living supports in home and community-based settings that people with disabilities would normally receive Medicaid coverage for if they were in assisted living facilities. In 2012, the U.S. Department of Health and Human Services, which partners with states to administer Medicaid, referred complaints about long waits for the services in Kansas to the Justice Department, the legal arm of the federal government. The department launched an investigation into whether the waiting lists violated the civil rights of Kansans with disabilities. …

Kansas Republicans Block Investigation Into State’s Medicaid Program
Source: Teddy Wilson, RH Reality Check, December 2, 2014

Kansas Republicans blocked a proposal to create a special panel to investigate possible ethics violations in the operation of KanCare, the state’s $3 billion privatized Medicaid program. Members of the KanCare Oversight Committee voted along party lines Tuesday to reject the appointment of a joint House and Senate committee that would be granted subpoena power to investigate the controversial KanCare program.

KanCare inspector’s background scrutinized
Source: Associated Press, June 2, 2014

A former lawmaker appointed to identify fraud in Kansas’ privatized Medicaid system has a background that includes a business bankruptcy and a DUI conviction. Phil Hermanson, a Republican who resigned from the House in 2013 after 2 1/2 terms, started the $77,000-a-year position as inspector general for the $3 billion-a year KanCare health care network in late April. The Kansas Department of Health and Environment, which named Hermanson to the job, did not announce his appointment, The Topeka Capital-Journal reported….

KanCare gets mixed reviews from patients, health care providers
Source: Scott Rothschild, Journal World, April 29, 2014

Patients, health care providers and others on Tuesday provided a mixed picture of the status of Gov. Sam Brownback’s privatization of Medicaid called KanCare. ….On Tuesday, several providers expressed frustration with dealing with the KanCare’s managed care organizations, while others said the new system was working fine….Mike Egan, owner of Hillside Village, a nursing home in De Soto, said it has cost him thousands of dollars to correct billing errors under KanCare. And Danica Case, controller of Newman Regional Health, a county-owned hospital in Emporia, said the slow payment of claims and wrongful denial of claims were costing taxpayers money….The meeting came as the Kansas Health Institute reported that the KanCare contractors lost more than $110 million in their first year of the program….

State reports on first year of privatized Medicaid services
Source: Kelsey Ryan, Wichita Eagle Tuesday, March 4, 2014

More than $2.3 billion was spent by the state during the first year of KanCare, according to a new report from the state. KanCare – the state’s privatized Medicaid program that started last year – has three administrative managed care companies: United Healthcare, Amerigroup, and Sunflower State Health Plan, a subsidiary of Centene. The new report details information about expenditures, enrollment and services of the program, which Gov. Sam Brownback claims will save the state an estimated $1 billion over five years….

Kansas’ privatization, limit of welfare orgs worries advocates / 38 percent are dropped from temporary aid program
Source: Associated Press, January 6, 2013

Advocates point to Brownback’s refusal to expand Medicaid under the federal health care overhaul, which could leave 120,000 to 140,000 low-income Kansans without insurance. They also fret about the administration’s decision to turn the delivery of Medicaid services over to three private health insurers in a system known as KanCare that started Jan. 1. Private insurers, advocates fear, will boost their bottom lines by refusing or restricting services to the 380,000 poor, disabled and elderly Kansans on Medicaid. The state counters that KanCare will be more efficient, and that privatization will stem rapidly growing Medicaid spending and save Kansas close to $500 million over five years. Sweeping Brownback-supported changes in May eliminated income taxes for an estimated 191,000 small businesses, but took away longstanding tax breaks for child- and dependent-care expenses and money spent on food taxes that helped a combined 430,000 Kansans. Before that, another policy eliminated food stamps to the families of 2,200 Kansas children, all of whom are U.S. citizens, because some income in their homes came from family members who were in the country illegally…. About 39,000 severely poor Kansans were receiving TANF when Brownback took office. After his administration instituted stricter rules, about 38 percent of those participants — or nearly 15,000 of them — were cut off. … Gilmore acknowledged that state officials do not have data to back up their claim that welfare recipients are finding jobs, but they feel it’s a natural assumption. …