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Clock Ticking On KanCare Extension After Federal Denial

File Photo/Kansas News Service
Mike Randol, director of health care finance at the Kansas Department of Health and Environment, recently told lawmakers that he is confident the state will get a requested one-year extension of KanCare, its privatized Medicaid program.

A third of the way to an end-of-year deadline, Kansas officials still do not have federal approval to extend KanCare.

In January, the federal Centers for Medicare and Medicaid Services denied the state’s request for a one-year extension of the waiver that allowed it to privatize its Medicaid program. The denial letter said neither the Kansas Department of Health and Environment nor the Kansas Department for Aging and Disability Services was doing enough to hold the three private companies that run the program responsible for providing services accountable to Medicaid rules.

Mike Randol, director of health care finance at KDHE, recently told Kansas lawmakers that he is confident the state will get the requested extension ahead of the deadline.

“I just think with the process they’ve asked us to go through, it is going to take more time than expected,” Randol told members of the KanCare oversight committee last week.

At the time of the denial, Republican Lt. Gov. Jeff Colyer called it “an ugly parting shot” from the outgoing administration of Democratic President Barack Obama.

“We expect this situation to be resolved quickly once the new administration in Washington comes into office,” Colyer said, referring to then President-elect Donald Trump, who was inaugurated days later.

Read the KanCare extension denial letter from the Centers for Medicare and Medicaid Services.

During the oversight committee meeting, Randol declined to predict when the extension would be granted but noted that his meetings with CMS officials have been “much more friendly” since the change in administrations.

Technically, KanCare is a demonstration project. The federal government gave the state permission to suspend regular Medicaid rules to demonstrate that contracting with three private insurance companies could improve care and slow the growth rate of Medicaid costs.

Since the inception of KanCare in 2013, the state has spent approximately $1.4 billion less than it would have under the old fee-for-service program, Randol said.

State officials plan to seek another waiver for what they are calling KanCare 2.0 but say they need a year to finalize their proposal.

Meanwhile, health care providers — nursing homes in particular — continue to complain about significant payment and administrative problems under KanCare.

“As we have reported every month for the last 14 months, there continues to be a Medicaid eligibility backlog in the thousands,” said Rachel Monger, director of government affairs for LeadingAge Kansas, which represents nonprofit nursing homes.

“Our members continue to report delayed cases, lost paperwork and communications frustrations,” she told members of the oversight committee.

A pilot project appears to have resolved the backlog problems at a dozen test nursing homes, Randol said. He said KDHE is in the process of implementing changes based on that project.

Still, several members of the committee said the assurances they are getting from agency officials do not square with the complaints they continue to hear from constituents.

“We hear things are improving, but when I go back home I’m not hearing the same thing,” said Rep. Susan Concannon, a Republican from Beloit, noting that it took more than a year to process the eligibility of one nursing home resident in her district.

Providers also are urging legislators toreverse a cut in KanCare reimbursement ratesordered last year by Republican Gov. Sam Brownback to help avert a budget deficit. They say the cut is hindering their ability to serve KanCare patients and maintain provider networks.

Restoring the KanCare cut is one of the issues that lawmakers are expected to consider when they return May 1 to finalize the state budget.

Jim McLean is managing director of the Kansas News Service, a collaboration of KCUR, Kansas Public Radio and KMUW covering health, education and politics in Kansas.