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Case Managers Raise Concerns About Kansas ‘Health Homes’ Program

Andy Marso
Heartland Health Monitor

Following complaints by legislators and case managers, state officials say they are changing how they notify people on Medicaid that they’ve been placed in a “health home” program to coordinate their care.

Mike Randol, director of health care finance for the Kansas Department of Health and Environment, acknowledged complaints from case managers who say they provide months of services to Kansans with mental illness only to find those services aren’t eligible for reimbursement because those clients have been placed in health homes.

Randol told the Robert G. (Bob) Bethell Joint Committee on Home and Community Based Services and KanCare Oversight last week that KDHE will begin sending notifications to case managers when their clients are placed in health homes.

“That’s the process we’re working on now, so that we can hopefully alleviate some of these issues and concerns,” he said.

KanCare, the state’s privatized Medicaid program, began implementing health homes for 36,000 patients with severe and persistent mental illnesses in August 2014.

The program was meant to better coordinate the physical and behavioral health treatments of people with mental illness by pulling together their care providers under the three private managed care organizations who administer KanCare.

As part of the federal Affordable Care Act, the U.S. government is promoting health homes for some high-cost patients by offering to increase the federal Medicaid match for their services from the traditional 60 percent to 90 percent for two years.

Susan Mosier, secretary of KDHE, said data on the first year of the program in Kansas should be available by the next KanCare oversight committee meeting.

“We have a process that we’re going through now to analyze the financial outcomes of health homes, because the idea behind health homes was that they would have better coordination of care, better integration,” Mosier said. “We’d have the better care and the lower cost. … We have seen that in other states.”

Benefits ‘not delivered’

Randol said he and other state officials recently completed a “listening tour” of 22 cities in which health home partners discussed success stories, including reduced emergency room visits.

But Roxanne Hidaka, co-owner of Case Management Services Inc. in Overland Park, said she does not think the program is working.

“All the fanfare about the benefits of people being in a mental health home are not being seen or delivered,” she said.

Hidaka and other case managers who testified at Friday’s committee meeting said they would welcome new notification procedures, but their concerns about the health home initiative go deeper.

Marylin Kubler, director of a Johnson County case management company called Jenian, said she wanted the new notification procedures in writing and the state to notify parents of people being placed in health homes as well.

Hidaka agreed, saying the Medicaid clients themselves often don’t understand the notification letters sent to them, especially if they have an intellectual or developmental disability (I/DD).

Hidaka said her clients often don’t know the benefits or drawbacks of a health home and don’t know that they need to opt out if they don’t want to participate. As a result, they take no action, are enrolled automatically and aren’t aware they should tell their case managers.

“This program is not ready and not working and is causing a lot of confusion in the I/DD community," she said.

Opt-out an issue

Sen. Laura Kelly, a Topeka Democrat, asked Randol what more could be done to notify parents about the health home enrollment as well.

Randol said there were some limitations, due to medical privacy laws.

“We can provide notification to the guardian or the responsible party that’s listed in that particular member’s file,” he said. “I don’t believe we would be able to provide that info to a member’s parent or friend if the individual is not listed as a guardian or responsible party.”

Kubler later gave Kelly a copy of a health home notification letter.

After confirming with Randol that was the form sent to people being enrolled, Kelly shared additional concerns.

“You have to remember who’s getting this information,” she said. “It’s not even that obvious to me what this means, and the people who are getting this, some of them are lacking some of the cognitive skills to decipher what this means. I think we really need to do something about this whole process.”

Kelly asked Randol if the state had considered making health home enrollment an opt-in program rather than requiring them to opt out.

Randol said that was “certainly something we could discuss,” but when Kansas began forming its program two years ago no other states were doing it that way.

“I think we were very concerned about the participation rate of members having to opt in,” Randol said.

Sen. Jim Denning, a Republican from Overland Park, called the state’s first attempt at health homes “a false start.”

“The opt-out was a major flaw,” Denning told Mosier. “It should have been an opt in.”

State officials had hoped to expand the health homes program this year to include other eligible Medicaid patient groups, like people with chronic conditions such as asthma and diabetes.

But Denning gathered enough Republican support to place a proviso in the budget delaying any such expansion for two years. 

On Friday he seemed to foresee the health homes initiative being scrapped altogether, asking Mosier if there was a way to provide for a “soft landing” so the program can wind down gradually before the 90 percent federal match ends.

“If a decision is made by the Legislature that you desire us to wind it down, then yes we would go through the process to do that,” Mosier said.

Andy Marso is a reporter for KHI News Service in Topeka, a partner in the Heartland Health Monitor team.

Andy Marso is a reporter for KCUR 89.3 and the Kansas News Service based in Topeka.
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