Changes to Medicaid affect patients, providers

Sept. 29--On Jan. 1, 2013, everything in Kansas changed.

Before then, the state of Kansas directly paid for the medical care of many Medicaid patients.

After that date, the state began paying private health insurance companies to make those payments and coordinate healthcare services -- a process called managed care.

United Healthcare, Amerigroup and Sunflower Health Plan are the three insurance companies currently providing this service.

As a result of the transition, the name of the Medicaid program in Kansas was changed to KanCare.

The change has had wide-ranging effects for both patients and providers.

Lee Wolf is the CEO of Konza Prairie Community Health Center, a health clinic that serves many Medicaid patients.

In KanCare's early days, Wolf said the change was difficult for patients to understand.

"They didn't know which Medicaid they were on. It wasn't always clearly explained to them," he said. "We had our case managers work with a lot of patients to establish which plan they were on."

For providers, the new model brought both rewards and drawbacks. While Konza receives less money from Medicaid than it has in the past, Wolf said the program covers a larger number of services.

Under KanCare, patients can receive dental checkups or mental health evaluations the same day as their doctor's appointment, which was difficult to do under the old system. However, with three separate insurance companies overseeing Medicaid patients, not all providers accept each type of Medicaid.

Wolf said this makes it difficult for Konza to refer patients to other providers.

All in all, Wolf said the change has hasn't been too drastic for Konza.

"It's probably a break-even," he said. "In the end, we likely haven't made quite as much money as we have in the past, but there aren't as many providers taking Medicaid or taking all three, so we haves an influx of Medicaid patients."

When insurance policies change, Wolf said his company makes the necessary adjustments so it can continue to serve its clients.

"We're just trying to save patients money and make enough money for ourselves to stay open to see more patients," he said.

State officials made the decision to move Medicaid to a managedcare system to improve patient

care while reducing state costs.

And according to Kansas Department of Health and Environment Communications Director Sara Belfry, the program is well on its way to achieving these goals.

Belfry said the insurance companies overseeing KanCare do more than just transfer payments -- they also look after the health of patients.

"The focus of these companies is to provide care in a timely manner that will keep people out of the hospital or nursing home, and to provide preventative care to people to keep them healthier, longer," she said.

According to Belfry, their efforts are essential to the well-being of KanCare members.

"Ensuring members get the right care they need, at the right time and in the right setting, keeps them healthier and out of high-cost settings, which may be unnecessary, like nursing homes and hospitals," she said.

Belfry explained the transition to managed care has improved outcomes for patients.

Under the new system, each Medicaid member has a care coordinator who can help them find providers and schedule appointments.

KanCare has paid a total of $1.6 million for dental services, which weren't covered under the old Medicaid program.

Disabled patients can apply for home- and community-based services (HCBS), which allow them to receive medical assistance outside of a traditional hospital.

While some of these services have waiting lists, Belfry said those lists have been decreasing since the transition.

More Medicaid patients have been seeing their primary care doctors under KanCare, and emergency room visits are down.

However, the cost side of the equation is mixed.

At about 5 percent growth per year, Medicaid costs are still rising. But under the old system, Belfry said costs were increasing about 7.4 percent per year.

Managed care has brought significant changes for both patients and providers.

But whether it's at the state or local level, health care officials remain dedicated to providing the best possible care for Medicaid patients.

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