It is not surprising that the Brownback administration’s ambitious plan to put virtually all of the sprawling $2.8 billion Medicaid program into three managed care companies (KanCare) has become very contentious and politicized. Policy aside, consider for a moment the over-heated political context.
First, we are in the middle of a very polarizing presidential campaign, the outcome of which will undoubtedly have a huge impact on the future of health care in general, and Medicaid policy in particular. It is not inconsequential that the state must obtain the necessary waivers and approval for its plans from the Obama administration’s health care point person, HHS Secretary (and former democratic Kansas governor) Kathleen Sebelius. Whether she will be inclined to grant a prominent republican governor HHS’ blessing to fundamentally restructure the Medicaid delivery system is, to put it mildly, not a slam dunk.
Secondly, our state legislature is in the process of redrawing the boundary lines for senate and house districts, an intensely political event that happens only once every ten years. Finally, the dominant political party in Kansas, the Republican party, is in the middle of a bitter internecine feud between the moderate and conservative elements of the party. All of this political background noise has almost overwhelmed the policy considerations contained in the KanCare proposal.
If the political obstacles weren’t enough, the policy challenges are equally daunting. Advocates for the aged and those with intellectual and developmental disabilities are very skeptical about the state turning over responsibility for their well being to managed care companies (MCOs). They fear that necessary social, occupational, functional and residential services will be denied, in part because they don't believe the MCOs understand or value the non-medical services essential to this population. They are urging the legislature to “carve-out” this population from the KanCare program.
For its part, the Brownback administration makes a compelling argument for including all Medicaid populations under the KanCare umbrella. They contend that better coordination which integrates medical as well as non-medical services will result in higher quality, better outcomes and improved health, while slowing the growth in costs. The Governor has also outlined a set of KanCare principles that are hard to argue with: improve quality, care/service coordination, and patient outcomes without reducing benefits, eligibility, or provider pay. Is it ambitious? Yes. Impossible? Probably not impossible, but certainly a challenge.
Given all the obstacles that stand in its way, it is possible that KanCare’s planned start date of January 2013 may have to be pushed back somewhat. However, even if it is eventually delayed a bit by politics or policy considerations, it is becoming increasingly apparent that the state’s approach to Medicaid is about to change.