Kansas proposes Medicaid work requirement

Oct. 27--TOPEKA -- The next version of Kansas' privatized Medicaid program will require about 12,000 adults to work, a stipulation no state's program currently includes.

State officials unveiled their proposal for KanCare 2.0 on Friday. The program serves more than 400,000 residents but right now has no work requirement.

The federal government must approve the proposal before implementation, a process expected to take months.

Gov. Sam Brownback's administration says the work requirements will improve lives, even as it stresses that only a relatively small number of people who are not currently working will have to find jobs. Of the 12,000 people the administration says will be affected, most are already required to work because they receive welfare assistance.

The administration couldn't provide a precise number of people who are not currently working but will have to under the new requirements.

"We think it does people good to get encouragement and help getting a job. We think that's good for people, it's good for how they feel about themselves, it's good for their quality of life," said Angela de Rocha, KanCare spokeswoman.

Kansas officials said its proposal would follow welfare work requirements already in place, which call for 20 hours of work a week.

Pregnant women, individuals with disabilities, those in long-term care and those caring for children under six would be exempt. The proposal calls for other additional exemptions as well.

A few states have proposed Medicaid programs that would include a work requirement, but the federal Centers for Medicare and Medicaid Services, or CMS, hasn't approved any of them yet. According to the Kaiser Family Foundation, Arizona, Kentucky and Pennsylvania's proposals would require recipients to work typically 20 hours a week.

Advocates for Medicaid recipients contend the work requirements are illegal, noting that federal administrations prior to President Trump didn't allow them.

"There's one goal for work requirements: it's to reduce access to services," said David Jordan, director of the Alliance for a Healthy Kansas.

Any work requirement actually implemented would likely result in litigation, he said.

The Brownback administration implemented KanCare in 2013. The administration has pointed to reduced costs in the $3.4 billion program even as some patients voice continuing frustrations with care.

Under KanCare, companies called managed care organizations contract with the state to provide health coverage.

In January, CMS denied a temporary one-year extension of the program, saying the program was "substantially out of compliance" with federal law and regulations, after investigators reviewed the program in October 2016. The agency approved a one-year extension earlier this month after Kansas took steps to correct problems found by CMS.

The KanCare 2.0 proposal calls for multiple pilot programs designed to improve care for individuals with disabilities, children in foster care and others.

The state wants to reduce the use of psychotropic medications among foster children, said Susan Mosier, director of the Kansas Department of Health and Environment. She called the use of such medications "high" among foster children.

And Kansas wants to reduce the number of placements foster children cycle through. One child, Mosier said, had 42 placements in a year.

"We want to focus on these children and on providing service identification, coordination and provision for these youth in foster care to increase stability at home and a school," Mosier said.

Public comment meetings on the KanCare 2.0 proposal are scheduled across the state during November. A hearing will be held in Wichita on November 16 at the Mariott, 9100 Corporate Hills Drive. The hearing will be 2 p.m. to 4 p.m. and 6 p.m. to 8 p.m.

"KanCare 2.0 builds on the successes we've had in the past in order to continue serving our most vulnerable citizens, assisting them with services that benefit their physical health and improve their quality of life," Lt. Gov. Jeff Colyer said in a statement. Colyer helped create KanCare and is poised to become governor if Brownback leaves for a position in the Trump administration.

Sean Gatewood, a co-administrator of the KanCare Advocates Network, said the "devil is in the details" of the proposal.

He said he didn't hear anything suggesting the state would increase oversight of the program, which was a concern of federal inspectors last year.

"I hope that there is," Gatewood said. "I hope that was just not mentioned, but we'll see."

Jonathan Shorman: 785-296-3006, @jonshorman

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