KanCare: ‘It’s a mess.’

Health care aid for low-income Kansans
not ready for prime time

By FINN M. BULLERS
Freelance writer/editor

“Ad Astra Per Aspera,” so the state motto of Kansas goes — “To the Stars through Difficulties.”

Most certainly, KanCare recipients have yet to reach “the stars” of low-income state health care.

But it seems the “difficulties” part of the state motto for me and thousands of Kansans has come with dump-truck loads of petty politics — crushing our faith in the gubernatorial leadership of Kansas.

Today (Monday, Nov. 25) was another emotional day in Topeka, where the 11-member KanCare oversight committee met for the second and last time to harness the beast of privatized, for-profit, managed care in Kansas, otherwise known as KanCare, or simply, Medicaid.

The next step for the oversight committee is to meet privately to form its recommendations to the state Legislature in January as to how effective they feel KanCare has been in its first year of operation.

Judging by today’s testimony, the lofty aims of Gov. Sam Brownback to slash $1 billion in Medicaid over five years — while at the same time “improving outcomes” for children, the elderly and the disabled — has been a hollow, Orwellian failure.

It’s a sad scenario in a state where cuts equal compassion and the rising need for health insurance for the state’s growing number of impoverished children is met with an even steeper curve in declining state assistance to the young — our future state leaders.

More than 250,000 children in Kansas — one in three — rely on KanCare for their health care coverage. And at the time childhood poverty in Kansas continues to climb, 4,000 fewer poor children received Medicaid in June 2013 than did six months earlier.

When rhetorically asked by Rep. Jim Ward, a Wichita Democrat,  how that oxymoronic dichotomy can exist, Christie Applehanz, vice president of public affairs for the Topeka-based Kansas Action for Children, simply shrugged her shoulders in exasperation and said, “That’s what we’ve been trying to figure out.”

STRIKE ONE, KanCare.

Next to testify was Dynel Wood, M.A., co-owner and director of operations for Options Services Inc., an Olathe-based service provider for about 50 people with disabilities. Options hires 55 employees.

“These people will lose their jobs if we cannot survive KanCare,” Wood said in written testimony.

As a small business owner, Wood is facing a cash-flow nightmare where in the last reporting period 30 percent of her payments were made successfully. Some providers reported a 0 percent success rate.

Wood can’t continue to do business that way. She has bills to pay — or fire caregiver. Or simply close up shop for good.

Before KanCare, Wood says her state reimbursements were issued within two weeks. Today — with a tangle of new billing codes and ever-changing process changes — it can take up to 12 weeks.

“The (managed care organizations) often can’t explain why claims are not paid or why information that was submitted is missing,” Wood told the oversight committee. “KanCare is not ready,”

STRIKE TWO, KanCare.

Waiting lists for Kansas residents on personal disability and mental-health waivers are 12 to 14 years long, says Jon Scott, CEO of Meadowbrook Rehabilitation Hospital in Gardner, Kan.

Scott is only of several agency providers who has paraded before the committee to share their frustration with a broken system with a high fever and a low white-cell count.

Same story from Rachel Monger, director of government affairs for Leading Age Kansas, a 160-member, Topeka-based assisted-living services firm with  25,000 elder clients each day.

Since her Oct. 7 testimony, “the problem we described with untimely and inaccurate payments have not vanished. And new problems have arisen,” Monger told the oversight committee.

She also said the administrative burden of dealing with three separate managed-care organizations with three sets of rules and business practices continues to be a problem. “We anticipate that it will continue throughout the life of KanCare,” Monger testified.

Higher administrative costs leads to higher Medicaid costs to recipients that leads to higher costs to taxpayers — the viscous KanCare circle  of life, and death.

There is only a finite set of dollars and a finite set of hours to dole out to an expanding number of Medicaid recipients, the state says.

And if I am to receive 24/7 care for my muscular dystrophy, diabetes and breathing machine that my doctors say I need, then I am an obstacle to reducing the state’s 2,800-person physical disability waiting list. How is it that I have become the source of the problem — and the target of blame by Gov. Brownback?

And now, Gov. Brownback is forced to play God, divining who lives and who dies in the state’s rationed world of health care politics.

STRIKE THREE, KanCare.

But the problems don’t stop there.

KanCare was designed to save money by moving people from institutions to home- and community-based services. But as of Nov. 21,  the current balance in the Kansas Department of Aging and Disability Services HCBS savings fund was $0.

Reports state Rep. Jim Ward, a Wichita Democrat who sits on the KanCare oversight committee: “Slow payments, more paperwork and mounting other problems.”

Ward reports that Kevin Unrein, chief executive and co-owner of a company that operates three Kansas nursing homes, said there is something he (Unrein) would like state policymakers to know about KanCare.

“It’s a mess,” Unrein said last week, leaving a meeting at a Topeka hotel conference room that brought together dozens of nursing home managers and representatives of the state’s three KanCare managed care companies. “I think it’s like Obamacare. It wasn’t ready and they pushed it and made it work.

“Most of our problems with it tend to be billing issues, not getting them resolved. It’s all these little things that need to get fixed and they never get fixed,” he said. “Things like paying the wrong rates. That’s very common. We used to bill (the state-run Medicaid program) on Thursday or Friday every week and payment hit the bank the following Friday. Now, about 20 percent gets paid by the following week.”

Unrein said his company is owed an estimated $500,000 overdue from the KanCare insurance companies for services provided at Lakepoint Corporate’s three facilities. Together, they house about 270 residents. More than half those frail, elderly people are enrolled in KanCare plans paid for by state Medicaid dollars.

“What Medicaid used to take one hour a week to do (in nursing home staff time), it now takes 40 hours,” Unrein said. “It’s basically doubled our billing costs. In the nursing home area, it ought to be pretty basic. Most of the people are going to be with us until they die. There’s not a lot of negotiating on hours and rates. It’s routine billing”

Unrein’s complaints about stalled or contested payments and added administrative burden are nothing state and KanCare company officials haven’t heard before from the state’s Medicaid providers, Ward reports.

Hospitals, doctors and pharmacists have all raised the same or similar concerns in recent weeks and months, he said.

“Denial is never a good strategy for solving problems, and it’s clear the Brownback administration is into heavy denial when it comes to the state’s low-income health program, KanCare,” Ward told the Wichita Eagle.

“Last year the Brownback administration turned over the $3 billion state health care program for the poor to three for-profit insurance companies, and the clear, documented, negative effects of that change are something the administration apparently doesn’t want to talk about,” Ward told the ewes paper.

“The problems center on four major areas: slow payments to providers for legitimate medical services; increased paperwork and cost for providers seeking reimbursements; confusing, inconsistent and inaccurate payments (providers bill for one service and get paid for another); reduced level of care for patients.

Ward said Wesley Medical Center in Wichita has seen a huge increase in denied claims that previously had been routinely paid.

“At the end of July, about $1.6 million owed Wesley by KanCare remained unpaid. Via Christi Health’s unpaid Medicaid bills more than 90 days old have increased 48 percent under KanCare.

“The problem is even more severe for small rural hospitals that depend heavily on Medicaid money. Prompt payment of claims or lack of it can mean keeping their doors open or not,” Ward said.

“The bad news continues. The Kansas Medical Society reports that doctors are having greater problems getting paid, have more claims being denied, and are swamped with paperwork that is at best confusing and unnecessary. Advocates for elderly Kansans cite delays in payments and serious problems with payment for hospice care.

“Sadly, this all adds up to a system that is struggling, where providers don’t get paid, and Medicaid’s clients in Kansas are being denied legitimate health care services,” Ward continued.

“If KanCare is to meet its goal of improved outcomes in the health care provided to children, elderly and our most vulnerable neighbors, the administration has to stop denying there are problems and get to work on the changes needed for it to work.”

Read an article about Ward’s concerns in the Wichita Eagle.

I don’t envy the work facing the KanCare oversight committee. It is as if they have dipped their toes in an oozing tar pit of political motivations and wrong-headed leadership from the top down.

And that’s why advocates for people with disabilities have to fight from the grassroots up — speaking truth to power, not just in Kansas, but wherever the cockleburs of injustice against the most vulnerable take root.

At first, the theoretical goals for KanCare appeared noble. But now — nearly a year into Kansas’ grand experiment with for-profit medicine — it is pure folly to ignore a crippled program on life support.

My hope is that the oversight committee will acknowledge that the emperor has no clothes — and no wardrobe in which to make a quick change before the KanCare parade commences.

Message to state Legislators: KanCare is not ready for prime time.

Perhaps it’s time to tear down and build anew, this time on a foundation of our collective Kansas values so that the stars of our shared humanity can once again shine through the difficulties of reaching to the heavens.
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You can reach Finn Bullers, policy adviser for the Greater Kansas City Spinal Cord Injury Association, at: finn.bullers@aol.com or 913-706-2894.
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