Social worker Gayle Taylor is part of a care provider network for a Kansas man who suffered a traumatic brain injury and compounds his predicament by engaging in substance abuse.
In mid-January, Taylor said she arrived at the Medicaid client's home to find him bleeding from an arm wound. He apparently didn't grasp how or where to get help and languished for five days without treatment.
Gov. Sam Brownback had turned over the state's $3.2 billionMedicaid program two weeks earlier to United HealthCare, Sunflower State Health Plan and Amerigroup companies to operate a managed- care system designed to improve care for 380,000 Kansans and save the state an estimated $1 billion over five years.
Taylor, who owns Burlington-based Therapy Services, related snippets of her client's situation during a Statehouse rally and a subsequent interview.
"What I'm so afraid of is, without proper care, people are either going to end up dead, homeless, in jail or in a nursing home. They will lose their independence," she said.
Kari Bruffett, director of the division of health care finance at the Kansas Department of Health and Environment, looked into the situation during the past week and concluded Taylor's client was receiving all services he was entitled. Bruffett was bound by confidentiality regulations, but said the case illustrated the complex medical and behavioral puzzles woven into lives of Medicaid program recipients.
"What we're able to confirm is he is receiving care coordination and is getting the services he needs," she said. "There are challenges for him."
However, Taylor said she remained uneasy about implications of KanCare as it related to people with brain injuries.
"I'm a skeptic about this particular population of people," she said. "It's going well with other populations."
Lt. Gov. Jeff Colyer, a surgeon who is taking a leadership role in Medicaid reform in the Brownback administration, said the introduction of private insurance companies to the mix would subject the state to growing pains. The strategy is to moderate costs with establishment of three competitive long-term managed care plans while maintaining comparable service levels to clients and payment rates to providers. He said during a Senate committee hearing KanCare had already saved the state $18 million.
"We have to make a transition, and we are very cognizant of that transition," Colyer said. "What we have done is we've built in a number of precautions."
He said the state attempted to help Kansans step into KanCare by requiring the three insurance companies to comply with Medicaid patients' previous plans of care during an introductory 90-day period.
"I personally won't be satisfied for a number of months on the success of the rollout," Colyer said.
Colyer said inadequacies of Medicaid would be resolved gradually by the state and federal government because the system had been plagued with shortcomings for decades.
He said a 9 a.m. daily teleconference with Medicaid beneficiaries and providers in Kansas was set up to field complaints, such as claims rejections or delays in payment for services. Problems raised and solutions derived are logged on a website, he said. The managed- care companies also have their own call-center system, and the state hired an ombudsman to oversee KanCare.
A key measure of the KanCare conversion will be whether health service providers in Kansas are paid in a timely way, Colyer said. Each of the three managed-care organizations, or MCOs, paid out more than $10 million in claims during January.
In Taylor's case, she had been promptly paid for most of her work on behalf of Medicaid patients. However, she said, for some reason none of the three managed-care providers had figured out how to pay bills for cognitive therapy. As of Saturday, she was owed more than $7,000 for treatment provided in January.
Cathy Harding, executive director of the Kansas Association of Medically Underserved, said she was pleased with responsiveness of managed-care companies to inevitable problems related to the launch of KanCare.
"We expected there would be bumps in the road," she said. "So far, I've been very impressed with response of the MCOs."
Sen. Jim Denning, R-Overland Park, lauded Colyer and the Brownback administration for implementation of KanCare. He said with 380,000 participants in Medicaid, it could be anticipated thousands of mistakes would be made during the learning curve.
Denning predicted a more accurate picture of whether KanCare was delivering better care at lower costs would emerge in the next month or so.
"You did a great rollout," said Denning, who compared it favorably to the Kansas Department of Revenue's implementation last year of a statewide system for licensing motor vehicles. "I think it went smoother than the DMV rollout."