By Gene Meyer | Kansas Reporter
Kansas wants to start the radically overhauled Medicaid plan Jan. 1, giving day-to-day administration of the $3 billion program to three health-care management insurance companies hired in June to run KanCare.
Kansas now runs a traditional Medicaid plan in which the state and the federal government jointly pay doctors, hospitals and other health-care providers directly for services to low-income and disabled patients.
Changing to a managed care plan, in which insurance specialists would potentially cap what gets paid, requires permission from the federal Centers for Medicare and Medicaid Services. CMS has not indicated when it might announce a decision or what potential regulatory strings might be attached to any approval.
“Guidance from CMS has not been finalized,” Kansas Lt. Gov. Jeff Colyer, said in national press teleconference called by a Florida think tank to promote similar Medicaid reforms throughout the U.S. Colyer is a surgeon named by Kansas Gov. Sam Brownback to head the Medicaid reform project.
But until a decision is made, neither Kansas nor any other state considering a similar change can resolve all of the details needed for the program to work. So, Colyer said Wednesday, “we have not made any official statements yet.”
All but three states in the U.S. – Alaska, New Hampshire and Wyoming — hire managed-care specialists to run at least part of their Medicaid programs. But few are trying to switch so massively as Kansas or Florida, which is seeking federal permission to expand to statewide a five-county pilot program established in 2006 by then-Gov. Jeb Bush.
Bush, a Republican, also took part in the teleconference sponsored by the Foundation for Government Accountability, a Naples, Fla., think tank that advocates Medicaid reform and free-market solutions.
Traditional Medicaid programs have become a “pay and chase system in which all the incentives are aligned to create a system that didn’t create a health care system we wanted,” Bush said.
But Greg Mellowe, policy director for the Florida Community Health Action and Information Network, or CHAIN, in Jupiter, Fla., counters that Medicaid reform requires more than simply turning the programs over to private managers. CHAIN is an affiliate of Families USA, a national health care consumers advocacy group in Washington, D.C., and both organizations have been critical of Medicaid managed-care efforts.
“There are reasons why, seven years later, legislation to take managed care statewide remains unfinished,” Mellowe said in a telephone conversation after the news conference.
“We’re still struggling with issues of accountability, and assurance about quality of care,” he said.
Total Medicaid spending hit $401 billion nationally in 2010, and it’s projected to jump to $586 billion in 2014, when expanded federal Affordable Care Act eligibility rules kick in, according to CMS Medicaid regulators. Totals could top $908 billion by 2020, the farthest year that CMS projected, if nothing changes.
States simply can’t afford to pay their share of those escalating costs, Bush said.
“If you don’t have Medicaid reform, you don’t have money for education or other needs, either,” he said.
Contact Gene Meyer at email@example.com