KanCare gets federal reprieve for one year

The federal government has granted a one-year extension of Kansas' privatized Medicaid program that provides coverage for more than 400,000 Kansans 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.

"This temporary extension allows Kansas to continue its existing demonstration, which provides statewide managed care to almost all Medicaid state plan populations for their physical, behavioral, and long term care services and supports," the letter says.

KanCare was rolled out Jan. 1, 2013, and was set to expire at the end of this year. It's authorized by a waiver that allows states to deliver Medicaid services in experimental or pilot models and the state is working toward an application for another five-year waiver. According to a news release, it will post its new waiver proposal Friday and issue a request for proposals for private companies to provide KanCare coverage in November.

The reviews have been mixed. In a statement Monday, Lt. Gov. Jeff Colyer, who helped develop the program, praised its success and said he was pleased with CMS' decision to grant the waiver.

"Since KanCare's implementation, health outcomes have improved for thousands of Kansans," Colyer said. "Emergency room visits are down, routine checkups are increasing, and Kansans are spending less time in the hospital and more time taking advantage of preventative care."

Health care advocates have complained of reduced care and long delays getting approval for the program. They said the extension approval was not a surprise, but they hoped concerns they raised about KanCare would be resolved when the state reapplies.

"What we had been hearing is that the Trump administration has been assuring the state that they would get the extension," said Sheldon Weisgrau, executive director of the Health Reform Resource Project.

CMS's initial denial came in the final days of former President Barack Obama's administration.

Weisgrau said the program would have been thrown into chaos had CMS denied the extension with the program expiring in less than two months. He said he hoped complaints raised in CMS' review last year would be resolved before a full reauthorization was approved.

"I still hear a lot of the same complaints from advocates and providers that I heard before," Weisgrau said.

Sean Gatewood, co-administrator of the KanCare Advocates Network, said he hoped Kansas would take the year-long extension to make sure improvements are made in its reauthorization request.

"There's no oversight of the program and there's massive conflicts of interest with case management by the (managed care organizations), with huge incentives to deny care," Gatewood said.

Managed care organizations are the companies that provide health insurance through Medicaid.

Weisgrau and Gatewood said they would like to see targeted case managers used to help recipients access their benefits and a robust ombudsman office to handle complaints with the system. Weisgrau said he would also like to see the program become more transparent to the public and less bureaucratic for health care providers who are trying to get paid by the system.

Nursing home providers have long complained KanCare's eligibility system made it difficult to do business. Residents' Medicaid applications waited long periods for approval while nursing homes provided uncompensated care.

Credit: By Allison Kite [email protected]