Hospitals slam Kansas' proposed Medicaid overhaul

Providers are concerned that a new waiver to overhaul Kansas' Medicaid program will impede access to care and further empower managed-care plans, which they claim lack proper oversight.

For years, Kansas providers have complained the state's Medicaid program, known as KanCare, was complex to work under and that it underpaid or didn't pay at all for services.

Rather than revamp KanCare's oversight of the plans, Republican Gov. Sam Brownback submitted a waiver late last month that appears to cede additional power to them, providers said.

The state waiver includes a work requirement proposal for so-called able-bodied adults, which includes a three-month coverage lockout penalty if beneficiaries don't comply. The state also seeks to impose a 36-month enrollment cap on those beneficiaries.

Kansas said the changes would force able-bodied adults to view Medicaid as a transitional program rather than permanent healthcare coverage. Since the state did not expand Medicaid, the new policies would impact mostly parents and former foster children.

Hospitals claim the state hasn't created an exception for adults who live in rural areas where there are few job opportunities.

"Making people ineligible for services through work requirements and time limits does not equate to self-sufficiency or earning levels that would allow them to purchase health insurance," the Kansas Hospital Association said in a comment letter to the CMS.

The group also raised concerns that the state may not have the administrative resources necessary to track whether adults are complying with the work requirement.

Several states have eyed work requirements for their Medicaid programs. North Carolina was the most recent state to submit a work requirement in its Medicaid waiver request. Arizona, Arkansas, Indiana, Kentucky, Maine, New Hampshire, Utah and Wisconsin also have pending requests with the CMS.

The Kansas chapter of the American Academy of Pediatrics also slammed it's state's proposal, noting that between 35% to 60% of foster children have at least one chronic condition requiring care and those needs continue after they turn 18. The state covers children until they are 19.

"Putting up barriers for needed care for this population would result in both medical and financial hardships for those with the most need at a time when they are just starting out on their own," the academy said in a comment letter.

The Obama administration declined to renew KanCare in January 2017, citing provider concerns with program oversight. But the Trump administration stepped in before KanCare expired, giving the state a one-year extension while it reviews the newly submitted waiver.

In addition to the work requirement and lifetime ban, the waiver requires Medicaid plans to implement innovative provider payment or delivery system design strategies that include performance and quality measures.

Plans must also perform health assessments and develop care-coordination strategies to address enrollees' health and social needs, including assisting members in finding affordable housing and food services.

Kansas has also sought to align Medicaid plan operations to streamline credentialing, prior authorization and the grievances and appeals process.

"Although (plans) make every effort to simplify their processes, interfacing with multiple MCOs in lieu of the single state Medicaid agency presents some additional administrative burden for providers," the waiver application said.

The CMS will accept comments on the 1115 waiver application through Jan. 27.

As of October 2017, Kansas has enrolled 385,603 individuals in Medicaid and CHIP according to the CMS. The program spends around $3 billion annually.