Mike Oxford: KanCare legislation must be heard

By Mike Oxford, March 19, 2018

Portrait of Mike Oxford

Mike Oxford is Co-Executive Director of Topeka
Independent Living Center, a pritate non-profit
organization that advocates for a fully integrated
and accessible society for all people with disabilities.

The Kansas Medicaid program, known as KanCare, is fraught with problems. To their credit, lawmakers have stepped forward to address some of the issues with the program. Legislators from both sides of the aisle — the need to fix KanCare is an issue that brings people together in Topeka — have proposed bills to begin the repair process.

But legislative leadership is blocking the path forward. In a misguided attempt to protect Gov. Jeff Colyer from a decision to expand KanCare — a move supported by more than 70 percent of Kansans — leadership is holding up all KanCare-related legislation.

State agencies have struggled for years to adequately administer KanCare. Since being privatized in 2013, most operations have been outsourced to three managed care organizations (MCOs) and other contractors.

The MCOs are responsible for providing a full range of health care and support services to more than 400,000 low-income enrollees, mostly children, seniors, pregnant women, and individuals with disabilities. The state has ultimate responsibility for the program, including determining whether Kansans are eligible for coverage and ensuring that the MCOs are appropriately meeting the needs of enrollees.

The state has failed to carry out these responsibilities. Kansans have faced long delays in program enrollment, resulting in denials of services and providers going unpaid. Vulnerable patients have had their services reduced without being informed of their right to appeal. Thousands of Kansans with disabilities face a years-long waiting list to receive home and community-based services. The list goes on and on.

Last year, the federal government issued two critical audits detailing a series of pervasive problems in KanCare. The audits concluded that the health, welfare, and safety of KanCare beneficiaries were at risk.

So, as noted above, lawmakers have responded. In the current legislative session, bills have been introduced to re-establish targeted case management for Kansans with disabilities; to cover tobacco cessation services; to suspend, rather than cancel, coverage for individuals who are incarcerated; and to delay the so-called KanCare 2.0, which promises to increase administrative complexity and red tape, resulting in higher costs and less coverage.

More needs to be done to fix KanCare, but these bills are a good start.

So, it is troubling that the Legislature has failed to take action on any of them. Legislative leadership, which controls which measures come to the floor for a vote, is worried that these bills to improve KanCare will become vehicles for amendments to expand the program.

For the past four years, Kansas has had the opportunity to expand eligibility for KanCare to cover 150,000 Kansans who fall into a “coverage gap” — they earn too much to be eligible for the current program, but not enough to qualify for financial assistance to buy private insurance.

As a result, most are uninsured with few affordable options for coverage.

Under the expansion, which has been accepted by 32 other states, these Kansans would gain health coverage and nearly the entire cost would be paid by the federal government. By refusing to participate, the state has forfeited the return of nearly $2.5 billion in federal taxes. Instead of coming back home, these tax dollars are being sent to California, Colorado, New York and other states to cover their residents. Meanwhile, thousands of Kansans go without.

A bipartisan bill to expand KanCare passed the legislature overwhelmingly last year. However, it was vetoed by then-Gov. Sam Brownback and the House failed to override the veto by only a handful of votes.

Now it’s an election year and a few legislative leaders are trying to protect Gov. Colyer from having to make a decision. So, they block any bills that may be used to move KanCare expansion, which despite strong public support is opposed by a few influential special interest groups.

The problem is that fear of KanCare expansion is also blocking KanCare improvement, and all stakeholders, including the Colyer administration, understand that KanCare needs to be improved. The care of hundreds of thousands of the most vulnerable Kansans is at stake.

The recklessness of the blockade is further evidenced by the experience of states that have expanded their Medicaid programs. Expansion brings in a flood of new money, allowing states to make program improvements, including the reduction of waiting lists for services, in addition to covering more enrollees.

It’s time to bust the blockade. Legislative leadership should allow debates and votes on bills to improve KanCare and to expand the program. Let democracy happen. It’s the reason we sent our representatives to Topeka in the first place.

Mike Oxford is executive director of Topeka Independent Living Center.


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