Every January I look into my crystal ball and attempt to look into the future. Sometimes I am very accurate with Nostradamus like powers, while other years I feel like Bill Murray in “Groundhog Day,” where he is stuck in a time warp reliving the same day over and over again. So what does 2018 have in store for people with intellectual and developmental disabilities?
As I gaze into my crystal ball the only thing I see is a foggy landscape with a bright light off into the distance. That bright light is the Kansas legislature that can either permanently destroy a system that once was the envy of other states or be its saving grace. The reason I mention this is because in 2018 providers will again ask the legislature to carve people with intellectual and developmental disabilities out of managed care (Kancare). There are many reasons why this carve out is necessary:
Managed care has not benefited people with intellectual and developmental disabilities. There is no empirical data that suggest managed care has improved the lives of people in long term supports and services.
Managed care companies cost the state anywhere from 6-10% in administrative costs. In the previous system it was 2.4%. This results in tens of millions of dollars leaving the state that could otherwise be invested back into the system and reduce the statewide waiting list.
KanCare does not address the needs of people with intellectual and developmental disabilities. According to the States own data, the percent of HCBS I/DD waiver participants whose service plans address their assessed needs and capabilities dropped from 99% in 2013 to 48% in 2015. Over that same span, the percentage of waiver participants who received services in the type, scope, amount, duration, and frequency specified in their service plans dropped from 98% to 68%.
The State has characterized care coordination, a service performed by the managed care organizations, as the foundation for improved care. Unfortunately, care coordination has not worked as designed; consumer satisfaction has declined as a result. In September 2017, Families for KanCare Reform and the Life Center of Johnson County conducted a statewide survey of parent/guardians regarding their opinions on KanCare. The results indicate that care coordination has not met the State’s expectation. Less than 2/3 of respondents know the care coordinator assigned to them. Just over half of respondents were satisfied with the frequency of communication with their care coordinator, about the same number, 60% were satisfied with the speed at which their child’s needs were met. Only 52% of respondents were satisfied with their care coordinator’s efforts.
The State has trumpeted KanCare’s ability to provide a “360-degree view” of a person’s well-being. The problem is that such a system has existed since the implementation of the Developmental Disability Reform Act of 1995. Through the DDRA, the local targeted case management system has provided wrap-around services for persons with I/DD to ensure that they receive the best services and care available.
Prior to the implementation of KanCare, Community Developmental Disability Organizations managed the system, and community service providers (CSP) used one process to request reimbursement for services rendered. With KanCare, the State has created a nebulous layer of system management that has tripled the administrative tasks for CSPs. They must now follow three separate and distinct processes to request reimbursement for services rendered, one for each MCO, in addition to those policies and procedures required by state statute and regulation. This has not reduced system fragmentation or broken down service “silos”, as was intended; rather, system confusion has increased, given that CSPs must now navigate three separate and distinct interpretations of regulation, interpretations that often times conflict.
There are so many problems with KanCare, for the first time in anyone’s living memory, the Center for Medicaid Studies (CMS) required the State to submit a corrective action plan for systemic non-compliance with federal regulations.
This is only a small sample of the problems with KanCare. The entire list would require a supplement to the newspaper. Those of you that read my columns are well aware that KanCare has had a detrimental effect on people with disabilities and it is time we do something about it. Our state association, Interhab, will be submitting a new bill to the Kansas Senate within the week that asks the legislature to carve our system out of KanCare. If this does not occur, we could be stuck in an ineffective, inefficient system for the next ten years if the state gets its new waiver approved. This will only lead to a further decline in services for people with intellectual and developmental disabilities.