Kansas

Kansas Flag

Managed LTSS Program

In August 2012, the state resubmitted to CMS its KanCare §1115 demonstration waiver application, seeking waiver authority to move all Medicaid populations into a person-centered integrated care system by January 1, 2013.  (Source: Medicaid.gov; CMS and Truven Health Analytics, 7/2012)
Waiver Application (Submitted 8/6/2012)

In December 2012, CMS approved KanCare and the state began implementing KanCare on January 1, 2013.
Approved Application (12/27/2012)

In December 2013, the state announced temporary postponement of its January 1, 2014 start date to incorporate I/DD waiver services into KanCare through a proposed §1115 demonstration waiver amendment.  However, the state agreed to continue working with CMS to resolve issues related to the existing §1915(c) waiver for I/DD members by February 1, 2014.  The state said it would determine the implementation timeline and any updates to the KanCare §1115 demonstration Special Terms and Conditions during its discussions with CMS (Source:  KDHE News Release, 12/27/13)

In January 2014, the state announced it had reached an agreement with CMS on the proposed amendment to the §1115 demonstration waiver for HCBS for individuals with I/DD (HCBS-I/DD).  Beginning February 1, 2014, HCBS-I/DD will be integrated into KanCare.  (Source: State Department for Aging and Disability Services Press Release, 1/30/14; KDHE News Release, 1/17/14) 
Amendment Approval Letter (1/30/14)
Amended Special Terms and Conditions (1/30/14)
Waiver Authority
Expenditure Authority

On September 9, 2014, the Kansas Health Institute reported that the three managed care organizations administering KanCare lost $72.6 million in the first half of 2014, after losing $110 million in 2013.  On September 7, Representative Jim Ward, who is a member of a KanCare oversight committee, questioned how long the three companies can sustain such losses.  (Source:  Kansas Health Institute, 9/9/2014)

On October 8, 2014, the Sacramento Bee reported that Democratic gubernatorial candidate Paul Davis has proposed reversing part of Republican Sam Brownback’s Medicaid overhaul in order to improve access for the DD population.  If elected, Davis plans to remove in-home support services for individuals with developmental disabilities from KanCare.  (Source:  HMA Weekly Roundup, 10/15/2014)

On November 10, 2014, the Kansas Department for Aging and Disability Services (KDADS) posted its Proposed Changes to HCBS Programs for public comment through December 20, 2014.  The posting included a summary of proposed changes in the draft HCBS waiver renewals for the Frail Elderly, I/DD, Physical Disability, and TBI programs.  According to the Kansas Health Institute, advocates for frail seniors and Kansans with disabilities plan to file objections to the proposed waiver changes due to concerns about service reductions.  KDADS officials plan to submit the final proposed waiver changes to CMS by January 1, 2015.  (Source:  Kansas DADS website, 12/2014; Kansas Health Institute, 12/15/2014)
Proposed Changes to HCBS Programs for Public Comment (11/10/2014)

On December 31, 2014, the Kansas Department for Aging and Disability Services (KDADS) filed with CMS several HCBS waiver renewals for the state’s Frail Elderly, I/DD, Physical Disability and TBI waiver programs.  The waiver renewals included several proposed changes; the most significant change would eliminate the automatic transition of individuals with PD from the PD waiver program to the Frail Elderly waiver program at age 65.  (Source:  HMA Weekly Roundup, 1/14/2015; Kansas Health Institute, 1/13/2015; KDADS website)     
Frail Elderly Program Renewal Application (Submitted 12/31/2014)
I/DD Program Renewal Application (Submitted 12/31/2014)
Physical Disability Program Renewal Application (Submitted 12/31/2014)
TBI Program Renewal Application (Submitted 12/31/2014)

On July 7, 2015, the Kansas Health Institute (KHI) reported on a National Disability Council forum in Topeka, Kansas. The forum was filled with disability advocates—individuals with disabilities currently account for 25 percent of the state’s Medicaid managed care model, or KanCare—who were expressing frustration with changes in service authorizations under KanCare. KanCare has responsibility for operation of the states’ MLTSS program. The Kansas model is widely viewed as important because it was the first state in the nation to enroll virtually all of its Medicaid recipients, most importantly individuals with intellectual/developmental disabilities, in commercial managed care plans. (Source: KHI, 7/7/2015)

In November 2016, Leavitt Partners (LP) released a report on KanCare, Kansas’ managed care system that includes management of LTSS for the state. The report was sponsored by the Kansas Hospital Association, the Kansas Medical Society, and the Kansas Association for the Medically Underserved.

The report notes a number of challenges with the MLTSS portion of the program, including:

  • Issues surrounding MLTSS network adequacy;
  • Access to non-emergency medical transportation; and
  • Issues with eligibility and enrollment.

The report also provides data relevant to the delivery of LTSS in either institutional or HCBS settings:

  • From 2012-2015, the state saw a 5 percent decrease in the number of beneficiaries residing in nursing facilities, and a 6.3 percent decrease in the number in public ICF/IDDs;
  • In 2013, 858 beneficiaries with physical disabilities were placed into HCBS from a waiting list; in 2014, 461 beneficiaries; in 2015, 1,025 beneficiaries, and; in August 2016 it was reported that the waiting list for physical disabilities waiver was essentially eliminated, although some interviewees for the report contested this fact.
  • In terms of LTSS expenditures, the percentage going to HCBS has trended slightly down when looking at data from the period of 2009-2014, which is contrary to national trends.

The report provides a number of different recommendations including: MCO administrative simplification and standardization; adjusting the medical loss ratio for KanCare; reinstituting pay-for-performance standards; increased oversight, transparency, and communication of MCOs and; increased benefit education for enrollees. (Source: LP Report 11/16;  Kansas Health Institute 11/17/2016) 

On January 19, 2017, the Kansas City Star reported that CMS denied a request for the state to extend operation of KanCare’s 1115 waiver, which includes Medicaid managed care, for another year through December 2018. In order to move forward with the approval process, the state must submit a corrective action plan to CMS by February 17, 2017. (Source: Kansas City Star 1/19/2017)

Health Homes

In September 2013, Kansas submitted to CMS an official Health Home SPA for Health Homes targeting people with SMI or other chronic conditions as a component of the KanCare §1115 demonstration waiver. (Source: Kansas Health Homes website; CMS Health Home Proposal Status website, 6/2014)
Health Home SPA Proposal (9/12/2013)

On February 24, 2014, the state announced it will begin implementing Health Homes on July 1, 2014.  (Source:  KanCare Advisor, 2/24/14). As of June 2014, the state is still planning to implement Health Homes in July 2014. (State Health Homes Herald, 6/2014) 

On July 1, 2014, the Kansas Health Institute reported that the state has chosen to indefinitely delay much of the implementation of the new Health Homes initiative because there are not enough providers statewide to address the initiative’s plan for treating Medicaid enrollees who are chronically ill with asthma or diabetes. This part of the initiative will now be reconsidered on January 1, 2015. Community providers that were preparing for the Health Homes initiative are concerned that this delay will kill the program altogether. (Kansas Health Institute, 7/1/2014; HMA Weekly Roundup, 7/2/2014)

On July 28, 2014, CMS approved the state’s Health Home SPA, effective July 1, 2014. (Source: Medicaid.gov State Resource Center)
Approved Health Home SPA (7/28/2014)

Case managers and legislators have expressed concerns regarding the state’s Medicaid Health Homes initiative, which falls under the state’s Medicaid managed care program, or KanCare, and aims to better coordinate health care services. Case managers cited issues surrounding beneficiaries being informed of their enrollment in the program but then lacking the ability to fully understand what it entails, or thinking to inform their case manager. Some legislators have expressed interest in letting the program sunset once the 90 percent in federal matching funds—a key feature of the Health Homes initiative—expire. (Source: KCUR.org 8/24/2015)

On July 10, 2016, an article in the Lawrence Journal-World detailed the ramifications of state budget cuts in Kansas attempting to fill a hole in the state budget, which include a $56 million cut for the state’s Medicaid program. Although the majority of the cuts stem from a 4 percent reimbursement reduction for Kansas providers, the article also notes that the state is also doing away with its Health Homes program, which aims to  coordinate care for Medicaid mental health screening and individuals with serious mental illness (SMI). (Source: LJWorld.com 7/10/2016)