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Disability Groups Don’t Care for KanCare

Family members and caregivers of Kansans with developmental disabilities are not happy with the Brownback Administration’s plan to include them in the new managed care approach to Medicaid services called KanCare.

This story was written and reported by Bryan Thompson

The Basics Of KanCare

The basic concept of KanCare is that by better managing the primary care needs of Kansans with Medicaid, the state can keep them healthier.  And if they can avoid going to the hospital as a result, the state will save money. 

The Kansas Department on Aging is responsible for these programs under the reorganization ordered by Governor Sam Brownback.  Secretary Shawn Sullivan says providers, like Johnson County Developmental Supports, who currently contract for these services are included.  They will be part of the provider network for all three of the managed care organizations that win state contracts.

Sullivan says some services may change.

“I can’t offer a blanket assurance that every single service that every consumer is receiving now will continue, because those are reauthorized on an annual basis, and needs change,” says Sullivan

Sullivan says CMS—the federal Centers for Medicare and Medicaid Services—wants the state to provide what’s known as “conflict-free case management”.  That means the agency providing direct services to a customer can’t be in charge of case management for that same consumer.    The case manager is the person who oversees all of the services a person with disabilities might need.

A Lack Of Expertise

Currently, agencies like Johnson County Developmental Supports provide services like personal assistants, for example, as well as the case management for those services.  Maury Thompson heads that group.  She says what people with developmental disabilities need are services to help them live as independently as possible, but that many managed care organization don’t have expertise in supporting the developmentally disabled.

 “Quite frankly, I’ve heard from some of them, we’re really not interested in having you all included in this, but if the administration includes you, of course we’re going to bid on the contract, and we’ll figure out how to do it,” says Thompson

Outcry At A Forum

Johnson County Developmental Supports organized a town hall forum, expecting about 50 people to show up.  Instead, 250 people packed the hotel convention room.  Many of them were frustrated at the prospect of having their loved ones forced into KanCare. 

Julie Sewell is the legal guardian for her 21-year-old, developmentally-disabled granddaughter, whose mother died more than a decade ago.  Sewell’s granddaughter is served by Johnson County Developmental Supports.

“Together we’ve put together a circle of support for her where she’s safe, and she’s covered for when I get hit by the bus, and I don’t know if she could survive this change,” says Sewell.

Sewell’s concern is that the private contractors who operate KanCare might not keep the support staff who’ve developed a long-term relationship with her granddaughter.

Another caregiver feels much the same way.  Anne Hull has two grown sons with developmental disabilities.

Hull says her sons need a case manager that knows about them.

“I don’t believe that someone assigned to us from a corporation—maybe even outside of our state—would have that knowledge,” says Hull.

A Race To The Bottom?

Bill Craig heads Lakemary Center, in Paola.  He fears the changes might lead to a race to the bottom.

“You would get the lowest bidder, the providers who are willing to cut the corners so that they can retain their ability to stay in business, and make promises that down the road cannot be met,” says Craig.

Craig says a better idea is to go ahead and apply managed care to the medical needs of people with developmental disabilities, but leave their ongoing services and supports out of it

“And this is the model that every state in the union, with one or two exceptions, has chosen, is to carve out long-term services, because they just don’t fit,” says Craig.

According to Craig, only two state have tried to include some of those services.

“I just don’t think Kansas is the place to be doing the experiment on these most vulnerable citizens,” says Craig.

Based On Best Practices

Secretary of Aging Shawn Sullivan says the Kansas proposal is based on what a number of other states have found to be best practices.  He insists that the managed care program needs to include everything, including social services and supports. 

Managed care organizations have until the end of January to submit bids for a share of the contract.

This story was written and reported by Bryan Thompson

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