Opinion: KanCare bully beats up disabled

For-profit, managed-care smackdown puts Rocky on the ropes

Freelance writer/editor

Remember the final minutes of Rocky II?

It’s post Bicentennial America. And the country still is in search of patriotic themes and underdog dreams. Actors Sylvester Stallone and Carl Weathers deliver in the second of six feel-good boxing thrillers that altogether grossed more than $1 billion.

In the end, both Rocky Balboa and Apollo Creed pummel each other in 15 rounds of bone-crushing, sweat-flying body blows until both fall to the mat in utter exhaustion.

Flash forward: It’s 2014 Topeka, Kansas, home of the KanCare political boxing championship. Two equally matched contenders have squared off in the first of what appears to be a long-running series of equally bloody bouts.

In one corner wearing patriotic satin trunks is underdog disability civil rights advocate Rocky Nichols with the Big Tent Coalition, an alliance of dozens of advocacy groups and home- and community-based service providers.
In the other corner are state Medicaid trainers prepping their scrappy, barbed-tongue pit bull — Angela de Rocha, the spokeswoman for Gov. Sam Brownback and his Kansas Department of Aging and Disability Services. She has on a blue satin unitard with red-and-white piping.

For years, the ring announcer bellows, promoters in both camps have been hyping the smackdown over Brownback’s for-profit, managed-care program known as KanCare. The experimental effort launched Jan. 1, 2013. Criticism has followed it ever since.

Neither side will back down, the announcer projects to the back row of fight goers. There is too much on the line. In 2016, Gov. Brownback wants to be President Brownback. To do that, he needs a win and a pit bull to bloody his opponent.

Enter de Rocha, who must help her boss impress hard-right extremists that he is The Tea Bag among all tea bags who want to gut this country’s safety-net social programs like Medicaid, as well as those pesky moderate Republicans sloshing about in the polarizing Red Sea of Kansas.

In a press conference last month, Rocky accused the Kansas Department for Aging and Disability Services of enacting policies aimed at restricting access to the state’s Medicaid-funded in-home services.

“People with disabilities, unfortunately, are far too often getting lost in KanCare,” said Nichols. “This is a crisis and, unfortunately, it’s a man-made crisis.”

State reports, Rocky said, show that while 7,000 people with physical disabilities received Medicaid-funded, in-home services in 2010, enrollment this year is down to about 5,500. “The numbers of people on the physically disabled waiver in the last three years have fallen off a cliff,” said Nichols, also the executive director of the Disability Rights Center of Kansas.

Body blow.

“Even more troubling,” Nichols said, was that the numbers of people on the KDADS waiting list have also been declining, reports Dave Ranney with the Kansas Health Institute News Service.

“The state of Kansas seems to have created a self-fulfilling prophecy,” Nichols said. “It’s taking steps to make it harder to stay on the waiting list, creating cracks in the system and then letting people fall through those cracks.” Under KanCare, the state appears to be spending more money on fewer people, the ring man yells at the crowd at the beginning of the next round.

Kidney punch from Rocky.

But Angela punches back, saying Rocky is misleading the public while the state is  cleaning up an overinflated waiting list that Nichols — for political reasons — played a role in hyping.

Ouch — an under-the-belt blow the referee didn’t see. And Angela’s press blitz prior to the fight only amps up the in-ring antagonism. Tension mounts. The crowd goes nuts.

“Over the last few years, there has been a concerted effort amongst advocacy groups, such as the Disability Rights Center, to add people to the waiting list, without much attention paid to accuracy or detail in order to provide a soapbox for Rocky Nichols so he can score cheap political points,” de Rocha said via email to Andrew Marso of the Topeka Capital-Journal.

Declining enrollment is driven by care cost increases, de Rocha punches back. Says her boss Sullivan: “It took more money to serve the same number of people.” And as people left the program their slots often were not filled because the department didn’t have the funding.

Today, Sullivan says, KDADS has the money — $9 million this year and another $9 million next year. But, he says, they have had problems finding people on the waiting list on whom to spend the money. Both sides blame the other.

“It’s taken us several months and several hundred phone calls to find people to fill the 100 slots that we’ve filled,” Sullivan told a reporter.

Sullivan’s conclusion: The waiting-list numbers were inflated over past years by health care services providers who stood to gain financially by higher numbers. Such manipulation, he said,  is why Brownback labeled the old Medicaid system “broken” and needed to be “fixed.”

Now, there are 5,515 people on the PD waiver. “We have room to go to 5,900 and we’re doing everything we can to get there,” Sullivan said. He claims the state can’t find people waiting for services because the lists are outdated and inaccurate.

But at a pre-fight press conference, Rocky introduced five people with disabilities who talked about troubles they’ve had with Sec. Sullivan’s department, including Tammy Leach, 50, of Topeka, who was critically injured in an automobile accident three years ago.

“I am a brain injury survivor who’s lost in the KanCare system,” Leach said. “I’ve been waiting patiently for services for five months. There are plenty of slots open and I’ve been declared eligible, but I can’t get the state to approve or deny my application. It just sits there,” Leach said. “I can’t get a straight answer from anyone. The state won’t let me rehabilitate my brain,” she said. “The state is holding me back.”

Another hard blow from Rocky, the winded, but determined underdog.

KDADS’ efforts to contact people on waiting lists have been half-hearted, Nichols said. “We can put them in touch with hundreds of people who’ve been declared eligible for services and been on the waiting list for years,” he said. “These are people who haven’t changed addresses for years, but they haven’t heard a word from KDADS. For the state to say they can’t find them is just not true.”

Nichols said he did not appreciate de Rocha’s slam. “That type of personal attack is so devoid of any merit that you have to wonder whether it was made just because the state can’t defend their own numbers,” Nichols said.

A flurry of punches to the abdomen leaves de Rocha dazed.

Nichols’ data centers on the number of Kansans with physical disabilities being served through the Medicaid waiver program meant to help them stay in their homes and communities.

In 2010, the off-the-cliff number served by the waiver dropped by nearly 1,500 people, despite the $9 million in additional money the Legislature gave last year for services.

So enrollment numbers are dropping at the same time the waiting list for services also is dropping, the ring announcer tells the crowd in the late rounds of the bout. In the corner, Rocky bows, scratches and mutters to himself, “Where are the disabled Kansans ending up?”

Angela sits in her corner, blood trickling for a small cut on her chin. “Costs for every person served has increased,” she, too, mutters to no one in particular.

That, Angela says, is partially because community disability organizations used to designate services Kansans with disabilities were eligible for and competed with each other for clients by attempting to qualify them for as many services as possible whether needed — or not.

And once the state took over the waiting list and tried to make contact, de Rocha said 70 percent of the waiting-list folks either couldn’t be reached, said they didn’t want services or were discovered to be ineligible.

“Had the contact information on the waiting lists been properly maintained and updated by those who entered the consumers’ names on the list in the first place,” de Rocha said, “those people would already be receiving services,”

0ne. Two. Three. Rocky staggers.

Nichols said he only wants to see KanCare work better for people with disabilities. “I don’t engage in politics,” Nichols told a reporter. “I engage in policy, and everything we’re talking about here is a legitimate policy discussion.”

With the bout winding down, let’s let the judge’s weigh in.

Senate Minority Leader Anthony Hensley, D-Topeka, has Rocky’s back. He’s known Nichols since he was 10 years old.

“He really does his homework and has his facts together,” Hensley said. “He would be the last person to inflate figures in order to promote his cause because he knows the credibility of him and his organization is on the line.”

De Rocha wants to compromise Rocky’s credibility because Nichols’ organization is delivering a message that could politically harm Brownback, Hensley said.

“Not only is it unusual, it’s inappropriate for a spokesperson of a state agency to criticize an advocacy group that is advocating on behalf of disabled people,” Hensley said. “If anybody’s playing politics, it’s Ms. de Rocha.”

But Rep. Dave Crum, R-Augusta, is in the KanCare corner, saying de Rocha’s waiting-list contentions ring true. Crum, chairman of the House Health and Human Services Committee, said the attorney general’s Medicaid fraud unit had found some abuse.

“I have confidence in KDADS,” Crum told the Capital-Journal reporter. “I think they’re truly doing all they can to ensure those who need services are going to get services.”

Tell that to Tammy Leach of Topeka, the brain-injury survivor.

In the final round, Rocky lands a devastating blow that knocks de Rocha down, but an exhausted Rocky loses his balance and falls to the canvas as well.

Rocky manages to stand up before the referee counts to 10, while de Rocha is counted out. The judges from the cheap seats on the Internet score the bout three-to-one in favor of Rocky.

But, says the weary announcer, there are still four more movies in the franchise and the campaign silly season has only just begun.

You can reach Finn Bullers at: finn.bullers@aol.com or 913-706-2894. Read his “Squeaky Wheel” column: http://www.usersfirst.org

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