Concerns remain about home and community-based services in managed care system
by Andy Marso, KHI News Service
Senators from both parties predicted a renewed effort to remove disability support services from KanCare during a candidate forum this week in Topeka.
The forum, whose host was the Topeka Independent Living Resource Center, focused on disability issues and featured candidates for state and federal office.
Mike Oxford, the center’s executive director, asked the candidates if they thought home and community-based services, or HCBS, should continue to be administered by three private insurance companies as part of the state’s managed care Medicaid program.
Senate Minority Leader Anthony Hensley, a Democrat from Topeka, told the crowd of about 50 that he was part of an effort to keep those services out of KanCare when it was launched in 2013.
“Unfortunately we were not successful in doing that,” Hensley said. “I, for one, would be more than willing to revisit that issue and try to carve that out.”
Gov. Sam Brownback’s administration agreed to leave home and community-based services for Kansans with developmental disabilities out of KanCare for the first year, in favor of a voluntary pilot program. That decision came after disability advocates and service providers argued that the daily support services were fundamentally different from the acute medical care that insurance companies had more experience covering.
Efforts to keep services for people with developmental disabilities out of KanCare past the first year were unsuccessful.
Sen. Vicki Schmidt of Topeka, the lone Republican legislative candidate who attended this week’s forum, said “there was a lot of fear, a lot of unknowns, a lot of questions that we had” about privatizing the services at the time.
The past two years have not dispelled those concerns, she said, citing persistent billing problems and delayed payments from the KanCare companies as examples.
Schmidt said she hoped the next Legislature would discuss separating home and community-based services again.
“Now we have history on our side, and history tells us about how big some of the KanCare issues are,” Schmidt said.
Schmidt’s Democratic opponent, Candace Ayars, is a public health specialist who formerly worked for the Kansas Department of Health and Environment.
Ayars said she opposed privatization of Medicaid services because health care is a unique industry with priorities that conflict with profit motives.
“There are probably two places where business has no business,” Ayars said. “One of those is health care and the other is education, and we’ve seen firsthand what trying to put those on a for-profit model does.”
More conservative legislators who have supported KanCare did not attend the candidate forum.
The Brownback administration has said KanCare will save the state $1 billion over its first five years while also improving health outcomes by coordinating care.
Angela de Rocha, a spokeswoman for state agencies, said she had requested information on how much it would cost the state to remove HCBS services from KanCare. Regardless of the financials, she said the state “does not believe it would benefit individuals receiving waiver services.”
HCBS providers have complained about increased billing complexities since the switch to KanCare and recent policy changes they say will cut their reimbursements.
Some people receiving the services have waged public battles against reductions in services. But the three KanCare insurers have produced clients who have praised their administration and expressed gratitude for the work of specific case managers.
Those stories are frequently aired at meetings of the Robert G. (Bob) Bethell Joint Committee on Home and Community Based Services and KanCare Oversight.
Renae Hansen is a former staffer on that committee who is now the Democratic candidate for Kansas House District 54.
During the forum Hansen said based on what she had heard at the committee meetings, she also favors changes to KanCare.
“There’s all kinds of issues and it really needs to be looked at,” Hansen said.
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