Kansas House Minority Leader Paul Davis, the Democratic candidate for governor, said Tuesday that if elected he would order a "top-to-bottom" review of KanCare.
Republican Gov. Sam Brownback spearheaded KanCare, which places the state's 400,000 Medicaid recipients under the administration of three private insurance companies, also known as managed care organizations (MCOs).
The governor has said the program is on track to meet its goal of saving the state $1 billion over five years through care coordination without cutting services, eligibility or provider payments.
But health care providers who serve Medicaid recipients have complained of late payments since the switch, and Davis said he's hearing from nursing homes, hospitals, doctors and home health agencies that are becoming financially strapped.
"It's causing a lot of cash flow problems for health care agencies across the state, and I think it's further proof this is just not working very well," Davis said at a Topeka elementary school on Tuesday. "What I want to do when we come into office is really take a top-to-bottom look at the KanCare program."
The Brownback campaign referred questions to the Kansas Department for Health and Environment, which administers the KanCare contracts for the three managed care companies: Amerigroup, Sunflower State Health Plan and United HealthCare.
Sara Belfry, a spokeswoman for KDHE, said the state is working with the companies to smooth claims processing. But she said some of the problems lie with the health care providers submitting the claims.
"Individual providers continue to struggle with some aspects of their billing," Belfry said via email. "We are making every effort to assist them. KDHE continues to work with all MCOs on provider payment issues that arise. We believe KanCare is working better and more efficiently for the people it serves than (the) old Medicaid system."
While some payments are delayed, Belfry said claim denials have been cut in half since fiscal year 2008 and now are around 15 percent.
Meanwhile, Belfry said the Medicaid recipients are seeing health care improvement under KanCare versus the previous state-run fee-for-service plan.
She highlighted $1.6 million in newly covered adult dental care, a more than one-third increase in primary care physician usage between 2012 and 2013, and a 4 percent drop in emergency room utilization in the same time frame. For recipients of home- and community-based services, who were added to KanCare this year, ER visits are down 27 percent, she said.
"The KanCare model encourages consumer-centered care at the right time and right amount with more flexibility to address individual situations than ever existed in Kansas Medicaid before KanCare," Belfry said.
Davis said he's "not necessarily against managed care" and that it can work well under some circumstances, but the provider complaints suggest KanCare is "clearly not working very well right now."
If elected, Davis said his administration would consult with medical providers and Medicaid clients to "find out what's working and what's not working."
Officials from KDHE told legislators that in 2013 none of the three managed care companies met the goals for timely claims payment that the agency set in the contracts the companies signed.
Representatives from the companies, which lost more than $100 million in the program's first year, have said the state's goals are aggressive but that they are committed to meeting them.
Belfry said the managed care companies paid 99.98 percent of "clean claims" within a month of receiving them, but the state is shooting for 100 percent.
"All three KanCare contracts require that the MCOs pay providers within 30 days of a clean claim being submitted, and the state is very serious about ensuring providers are paid promptly," Belfry said.
Davis also said Tuesday that it is important for the state to have an inspector general for the KanCare program, but he questioned whether the current position, housed within KDHE, provided enough independence for the IG to act as a proper watchdog.
He also questioned the administration's previous decision to appoint Rep. Phil Hermanson before going through a Senate confirmation hearing.
"Clearly the last person they put forward was not qualified for the job, and I hope we can find somebody for that job who is well-qualified," Davis said.
Davis said he had no names in mind.
Belfry said KDHE is setting up interviews with candidates for inspector general.
Keen Umbehr, the Libertarian candidate for governor, also has been critical of KanCare.
