One phrase that I dislike using is I told you so. It sounds pretentious, mean-spirited, almost revengeful, but in this situation, I cant resist using it. I can hear my mother yelling at me right now Timothy Lee, which is my given name and used only when she is disappointed in me, you know better than that. I cant help it though, it is so fitting. What am I so visionary about you ask? KanCare is the answer.
Recently, the Kansas Legislative Post Audit (LPA) released their report Medicaid: Evaluating KanCares Effect on the States Medicaid Program and its findings reinforced what I have been saying about KanCare for six years now; its not working and its never going to work. First of all, managed care companies are there to make a profit and according to the audit, in 2015 and 2016, they received $400 million more in payments from the state than what they paid out in claims. Thats $800 million in two years. That money could have been used to eliminate the states waiting list of over 4,000 people waiting for services in Kansas, helped fund schools appropriately and the states transportation program. Instead, that profit went to out-of-state mega insurance companies whose lobbyists freely roam the halls of our capital building in Topeka. The audit also found that per-person costs declined by 9 percent, which means services are being reduced, yet it shows total Medicaid costs remained stable. From that inference, the LPA indicated that Kancare did not appear to have helped contain Medicaid claims costs.
In addition, the audit found significant data reliability issues that prevented the LPA from assessing Kan-Cares impact on outcomes. They also had issues with KDHEs oversight of Kan-Care. If this report does not scare you by now, it should. The state is handing out billions of dollars a year to the three managed care companies and the state doesnt have data reliable enough to determine whether the system is working or not? I can tell you from first-hand experience that it is not.
Another finding was that KanCare had little to no effect on inpatient care. The managed care companies claim that there has been an increase in preventative care, but the evidence indicates it has not resulted in a decrease in the amount of time people remained in the hospital. The audit even notes that moving the states most expensive beneficiaries (individuals with disabilities) from a fee- for-service model to managed care did not help reduce the need for inpatient care as intended. What is also interesting about Kan-Care is that one of the goals of the program was to reduce institutional care across the state, but what the audit found was that admissions to nursing homes increased 16 percent after KanCare was implemented.
This is just a short list of all the problems with Kan-Care that the LPA audit found and when you combine that with the Centers for Medicare and Medicaid Services (CMS) audit from 2016 in which they found that the states oversight of the managed care companies had declined and that the managed care organizations had failed to comply with federal regulations, you have to wonder why the state continues down this path.
Now for the I-told-you-so part. The number of columns I have written about managed care between its implementation six years ago to current is staggering. In each case I explained why it would not work for people who received long term supports and services. I mentioned that it would not save money. I mentioned it would result in reduced services. I mentioned it would not improve outcomes. I mentioned it would not reduce silos. I mentioned it would not improve efficiencies. I mentioned until I was blue in the face, but no one would listen within state government. We do have local support from our area legislators such as Sen. Goddard, Sen. Bruce Givens, Rep. Lusker, Rep. Thompson, and Rep. Hibbard, but without the support of leadership, nothing can be accomplished.
In all honesty, because Tri-Valley had to be included in KanCare, I wish it would have worked. It would have saved us from six years of inefficiencies, poor communication, financial issues, and the total breakdown of a system that once performed so well that other states looked to Kansas for how to run programs for people with disabilities. Now they look at us to determine what not to do. It will take us years to recover from this mess, but until the state administration and legislative leaders decide to leave KanCare, people with disabilities, their families and agencies will continue to suffer.
