LAWRENCE, Ks. – The Kansas Health Policy Authority is being restructured. The Authority administers the state's Medicaid program, oversees health benefits for state employees, and provides health policy advice to elected officials. Governor Sam Brownback wants to cut the agency's staff in half, eliminate its independent board, and reassign the agency's responsibilities. Kansas Public Radio's Bryan Thompson reports on some of the implications of these changes.
The Kansas Health Policy Authority isn't completely going away, but Governor Brownback is folding the agency's responsibilities into the Department of Health and Environment, a cabinet-level agency controlled by the governor. One of the driving forces behind Brownback's decision is Medicaid, a program that provides medical care to poor children and Kansans with disabilities. The Health Policy Authority currently administers Medicaid, but Brownback wants more control of the costly program.
"This is one of the major cost drivers for every state in the country, and in a down economy it grows even more than it normally would," says Brownback. "And it has a normal growth pattern just because of the aging of a society."
Currently, Medicaid consumes one in every five dollars of the state's budget, and Brownback wants to change the way the program operates.
"I want to deliver a higher quality service to Medicaid recipients," says Brownback. "And I'm sincere about that. I want their experience to be better at the same time we drive costs down. I believe this is fully doable."
Merging the Health Policy Authority into the Department of Health and Environment and giving the governor more control over Medicaid spending is supposed to streamline state government, and save money. Democratic Governor Kathleen Sebelius proposed much the same structure in 2005.
"What it would give us is that data and the purchasing side of health care programs, cutting through some of the red-tape and bureaucracy and really running it as an insurance company which it is," said Sebelius. "We think we can be much more strategic and really lower cost and streamline administrative overhead."
But the Republican-controlled legislature insisted on having health policy controlled by an independent board, which Brownback now plans to eliminate. Former Republican state senator Jim Barnett was one of the prime architects of the Health Policy Authority. He says removing politics from health policy was one of the main reasons for creating the independent board in the first place.
"They certainly came forward with good ideas, and I hope that data driven approach is not lost," says Barnett. "If it is lost, we will look back and I think say it may have been a mistake to move it out of the independent nature and back into the political realm."
One of the ongoing problems faced by the Health Policy Authority has been a chronic backlog of Medicaid applications. The agency expects to eliminate that backlog this Spring. But Brownback's proposed budget would have the Authority operating with only 144 full-time employees about half the current number. Some, like Barnett, wonder whether that's enough staff to stay ahead of applications for the program.
"If you cut drastically those state employees who are going to lower the backlog, then it's going to be very difficult," Barnett says.
Making any further administrative cuts at KDHE would appear unlikely. The new KDHE Secretary, Dr. Robert Moser, said as much at a recent legislative hearing.
"The administrative side of things is always where you expect to find some savings. That's been tapped into a lot," Moser said. "There's not a lot of wiggle room left that I have the luxury of being able to sit up here and tell you, yeah, I can do this.' It's coming down really to where we're going to have to decide what programs are of value."
Moser isn't sure yet where additional cuts might be made, but he knows what's off-limits.
"As the governor said in his state-of-the-state address, we have no intention of reducing the numbers that are on Medicaid, that if they qualify they remain on it," Moser said. "And my goal obviously as a physician has always been patient service."
Moser faces a daunting challenge: finding some way to make Medicaid better for patients, without cutting anyone from the program, while operating one of the largest agencies in state government with considerably fewer employees.