TOPEKA — Kansans are being forced into nursing homes prematurely because of a flaw in KanCare, the decade-old program that administers Medicaid, an advocacy group says.
Kansas Advocates for Better Care is calling for the state to return to an independent case management system to serve seniors who qualify for KanCare. Under that system, employees of the state’s 11 area agencies on aging helped qualifying seniors find housekeeping, cooking, bathing and other services that allowed them to stay in their homes. The Central Plains Area Agency on Aging performed that role in Sedgwick, Butler and Harvey counties.
In 2013, the state changed to a managed care system, contracting with insurance companies to coordinate health care for Kansans enrolled in Medicaid in what then-Gov. Sam Brownback billed as a more efficient approach. Employees of those companies — United Health Care, Sunflower and Aetna — took the place of area agencies on aging employees.
Dan Goodman, executive director of KABC, said the conflict of interest is obvious.
“They try to discourage costs whenever possible,” Goodman said, adding that seniors “sometimes are given advice that’s not necessarily in their best interest. We feel like a professional needs to be there to help them navigate and negotiate problems with their best interests in mind.”
Goodman, who previously headed the Johnson County Area Agency on Aging, said some of the insurance companies’ case coordinators have “huge territories” with caseloads of 200 people.
“You can imagine trying to manage that. Individuals who need help don’t typically get timely assistance, nor do coordinators usually have a good sense of what’s available in any town.”
The result is that Kansans are leaving their own homes for long-term care facilities, where they encounter a whole other set of well-documented problems, Goodman said. “For a lot of reasons, the facilities are not well staffed. Their provider-to-resident ratio is not good. We’re forcing them into facilities where they don’t want to be to receive poor care. We prefer for them to be in the community with the services they need.”
According to the United Health Foundation report last year, Kansas had the third-highest percentage of people living in nursing homes with a definition of “low-care need resident” of any state.
About 6,800 people who qualifiy for KanCare under the “frail elderly” waiver are without independent case management services, according to KABC. People who qualify for the “physical disabled” or “brain injuriy” waivers are also affected by not having this waiver.
The issue is surfacing now because the state is preparing to request proposals from companies who want to manage KanCare starting in 2025. Goodman said returning to a case management system would not cost the state additional money, since the necessary money could be pulled from the upcoming contracts. KABC unsuccessfully lobbied Kansas legislators to make the change. The decision now rests with the heads of the Department for Aging and Disability Services and the Department of Health and Environment.
“They answer to the governor,” Goodman said. “It’s an administrative decision.”
KABC is urging Kansans to let state officials know how they feel by contacting Amy Gajda at KDHE at kancarerenewal@ks.gov.
