Kansas Advocates for Better Care says grievance process stacks deck against beneficiaries
by Andy Marso, KHI News Service
The leader of an advocacy group for older Kansans told a legislative committee Friday that the state’s grievance process for Medicaid claims has been stacked against beneficiaries since the state moved to managed care in 2013.
Mitzi McFatrich, executive director of Kansas Advocates for Better Care, said the beneficiaries have no one independent of state government to advocate for them if they disagree about their medical care plan with one of the three private insurance companies that administer Medicaid.
“This leaves consumers on an uneven playing field that tilts against them,” McFatrich told the Robert G. (Bob) Bethell Joint Committee for Home and Community Based Services and KanCare Oversight.
The state rebranded its Medicaid program as KanCare after placing all such services under three private insurance companies that also are known as managed care organizations (MCOs).
Medicaid is funded through a combination of state and federal dollars, and McFatrich questioned whether the KanCare program meets a contractual obligation with its federal partners to develop a “qualified, independent, conflict-free entity” to help beneficiaries resolve grievances.
The KanCare program has an ombudsman, Kerrie Bacon, but the position is housed within state government and is prohibited from working on behalf of a beneficiary who has filed a grievance with one of the MCOs.
McFatrich said KanCare beneficiaries and their families have reported about employees for the state or the MCOs discouraging them from filing those claims.
“An independent and able-to-advocate for KanCare members ombuds program is needed to protect KanCare members’ rights to due process through the appeals and fair hearing process,” she said.
McFatrich’s group has developed a guide outlining the grievance process for KanCare beneficiaries. It plans to post the guide on its website.
Some Democrats have called for an independent ombudsman since the beginning of KanCare, but the idea has gained little traction among Republican legislative leaders. The KanCare committee took no action on McFatrich’s concerns Friday.
Friday’s meeting also included:
• Continued concerns about home- and community-based services intended to keep Kansans with a variety of disabilities out of institutions. The list of Kansans with intellectual and developmental disabilities awaiting such services remains higher than 3,000, while waiting lists for those with other types of disabilities are declining, even as fewer of them are receiving the services. State officials believe the waiting list for Kansans with physical disabilities — also in the thousands just a few years ago — will be eliminated by the end of the year. Rosie Cooper, executive director of the Kansas Association of Centers for Independent Living, challenged committee members to find out how that’s possible, given that the total number of people with physical disabilities receiving services also is declining. “Let’s take a closer look,” Cooper said.
• Susan Mosier, secretary of the Kansas Department of Health and Environment, briefed the committee on the search for a KanCare inspector general, a position that has been vacant for more than a year. Mosier said a bill passed last session that allowed KDHE to take the position outside the civil service system has been a boon. That allowed the agency’s leaders to increase the salary, she said, making it more attractive to people with relevant experience. “We have reposted the position and had some more applications,” Mosier said. “To date none of those applications have met the criteria for the position, but we will continue to search.”
• Mosier also gave an update on the Kansas Eligibility Enforcement System, a long-delayed $138 million computer upgrade intended to knit together eligibility determination for several state assistance programs, including Medicaid. Mosier said KDHE is in the midst of the second phase of a three-phase rollout, focused on eligibility for Medicaid and the Children’s Health Insurance Program (CHIP). Last month the agency finished migrating Medicaid and CHIP data from the old system, and Mosier said eligibility now is being processed strictly through KEES. She said the third phase — adding eligibility for other assistance programs run through the Kansas Department for Children and Families — is scheduled for late spring 2016.
The nonprofit KHI News Service is an editorially independent initiative of the Kansas Health Institute and a partner in the Heartland Health Monitor reporting collaboration. All stories and photos may be republished at no cost with proper attribution and a link back to KHI.org when a story is reposted online.
– See more at http://www.khi.org/news/article/advocacy-group-calls-for-independent-kancare-ombudsman#sthash.Q6DRhU6V.dpuf