Advocates Tempering Managed Care Overhauls of Medicaid in Kansas and New Hampshire
April 26, 2013 01:12 PM
On April 25, hundreds from the disabled community protested outside the Kansas statehouse for a permanent “carve out” of long-term developmental disability services (LTDDS) from managed care. Advocates are hoping to secure a permanent carve out following the return of the Kansas Legislature to finish its 2013 session on May 8.
Governor Sam Brownback (R) initiated Medicaid reform on January 1 - called KanCare - which enlisted almost all of Kansas’ 380,000 Medicaid beneficiaries into managed care plans administered by Amerigroup, United Healthcare, and Sunflower State Health Plan.
The intention of the Brownback Administration is to eventually include LTDDS in KanCare, though service providers and other advocates have so far successfully lobbied for a year-long delay, until January 1, 2014.
Interested groups have noted problems with the managed care organizations (MCOs) in KanCare since its implementation. Kansas Pharmacists Association found a lack of transparency with pricing, as well as reduced or delayed payments for durable medical equipment. Community Health Clinic of Southeast Kansas expressed concerns around authorizations of medications, as well as payment delays. Despite noted concerns, administration officials state that concern over MCOs is based on “misinformation,” and instead assert that the MCOs are dealing with problems with a “workman-like approach.”
In New Hampshire, advocacy efforts have contributed to establishing checks and balances on MCO implementation. To protect both enrollees and providers, and “recogniz[ing] the concerns and challenges surrounding managed care implementation,” on April 10, New Hampshire Governor Maggie Hassan (D) issued an executive order creating a panel to advise the Governor on the state’s implementation of managed care in Medicaid.
This panel will include experts on managed care, adult health care services, and developmental disabilities, among other areas. The president of the Manchester, NH based provider Independent Services Network is a member of the panel. The first meeting of the panel, named the Governor's Commission on Medicaid Care Management, will occur within 30 days from April 10.
To see the full story on Medicaid reform in Kansas, click here and here.
For an article highlighting the concerns with KanCare, click here.
For more details on New Hampshire’s new executive order, click here.
Home health providers should be aware that the move to managed care in Medicaid faces opposition from beneficiaries and interest groups alike – and that providers are also not powerless or voiceless in the matter.
Stakeholders can be very useful in improving a state’s transition to managed care in Medicaid. Likewise, if these stakeholders have outright opposition to using managed care in Medicaid, the forums are there to voice those opinions. The main point is that the nature and scope of any state’s consideration or movement to Medicaid managed care is neither automatic nor a decision made in a vacuum.
Home health providers are encouraged to keep abreast of managed care transitions in their states, advocate on a state level, and to contact NAHC with any questions or concerns.