That’s when Kansas’ Medicaid managed care system — called KanCare — will take charge of all home and community-based services for about 8,500 people with developmental disabilities, most of them adults. What concerns families and advocates the most is that the three for-profit national insurance companies that run KanCare will be responsible for a statewide program that they’ve never managed in Kansas or elsewhere. They’re also worried that the need to make a profit ultimately will destroy a system families and advocates think works well.
While Kansas will become the first state to make such a leap, it is being watched closely elsewhere, as at least two other states — Louisiana and New Hampshire — are considering moving in the same direction.
By next year, more than two dozen states are expected to have set up programs to transfer frail elderly, mentally ill or individuals with physically disabilities into managed care for home and community-based services. But in most states, those with developmental disabilities — people with impairments such as cerebral palsy, Down syndrome and autism — have been excluded from managed care for these services because their needs are so specialized.
“There is a great deal of fear in the community that these big private health plans don’t know much about this population,” said Maureen Fitzgerald, disability rights director for The Arc, a national advocacy organization for those with developmentally disabilities. “These are such vulnerable people. Mistakes that are just inconvenient to some can be devastating to them. If the home care person doesn’t show up, you could be lying in your bed all day. It’s kind of scary.”
Only a handful of states, including Michigan and Vermont, have moved individuals with developmental disabilities into managed care for long-term services. They’ve mostly relied on existing networks of community-based nonprofits or county agencies or have made themselves the managed care organization. None has turned exclusively to national managed care companies.The Kansas City Star reports on a federal panel asking why Kansans with developmental disabilities no longer get services for which they previously qualified.
Members of the National Council on Disability pointedly put that question to Shawn Sullivan, director of the Kansas Department for Aging and Disability Services, and Susan Mosier, state Medicaid director. The council, appointed by the president to advise his administration and Congress on national disability policy, has held two days of hearings in Topeka this week.
It spent almost all of Thursday focused on KanCare, the state’s new managed-care program for the poor and disabled.
Working through three private-sector insurance companies, KanCare has been managing medical care since Jan. 1. Next month, it’s scheduled to take over management of daily living services for the developmentally disabled.
Disability council member Gary Blumenthal, a former Kansas legislator and social services official, continuously pressed to know how the previous government-run Medicaid system could decide that a disabled person needed 24/7 attendant care, while KanCare thinks the same person can get by with about 40 attendant hours a week.
Blumenthal also questioned whether the managed-care system is using a lower set of standards to make such quality-of-care decisions. Sullivan replied that the standards are the same.
“The difference is pre-KanCare, those weren’t always followed and post-KanCare, they are,” Sullivan said.