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It’s Not Right That Kansas Outsources Its Most Vulnerable Residents’ Care

It’s Not Right That Kansas Outsources Its Most Vulnerable Residents’ Care

What if you couldn’t talk, you had a really bad stomach cramp and the new careworker had yet to figure out the unusual way you signal your discomfort, pacing endlessly in the kitchen of your group home?

Kansas families with relatives who have developmental disabilities are bracing themselves for the start of 2014. Beginning in January, national for-profit insurance companies will be running KanCare, Kansas’ Medicaid managed care system. The problem is, the companies have never managed such a program in Kansas or anywhere else.

Outsourcing long-term services for those with developmental disabilities to for-profit providers poses many risks. Leaving the day-to-day care of a highly vulnerable population in the hands of companies whose main concern is profits means that the individual needs of many people could fall through the cracks.

As a recent investigation of private schools for students with disabilities in New Jersey shows, outsourcing services opens up the potential for abuse of public funds. Just as Kansas is paying for profit companies to manage Medicaid services for thousands of people, so do many public school districts in New Jersey pay tuition and transportation costs to send disabled students to private schools. A recent investigation by NJ.com found that some of these schools have been using taxpayer funds for luxury cars and for hiring their own relatives.

Kansas Governor Pushed Plan to Outsource Care

Debra Lipson, a senior researcher for Mathematica Policy Research, a nonpartisan think tank, emphasizes that Kansas’ plan to privatize services for those with disabilities presents “huge challenges” as the three insurance companies (Amerigroup, United Healthcare Community Plan and Sunflower State Health Plan)

“… don’t have a lot of models to follow, and it’s a highly vulnerable population, and therefore you can’t skimp on oversight. And there’s a risk when you’ve got national companies that don’t bring a tremendous amount of experience in this area.”

Parents and siblings of adults with autism, intellectual disabilities, cerebral palsy and other disabilities are fearful about what will happen to their loved ones under the new plan that was implemented by Republican Governor Sam Brownback’s administration. In January of 2013, nearly all of the 380,000 people on Medicaid in the state were transferred into KanCare with the plan to (in the words of Brownback) “improve care coordination and reduce growth in Medicaid spending” by $1 billion over the next five years.

The state is now paying a fixed amount for each member per month to the three companies to provide medical, pharmaceutical and mental health care to KanCare members who are elderly and/or have physical disabilities. Services for those with developmental disabilities have been delayed until January 2014 after parents, advisers and providers protested. In May, more than 1,000 rallied outside Kansas’ Capitol in Topeka, with many wearing T-shirts proclaiming “Not Worth the Gamble.”

The Kansas Department for Aging and Disabulity Services says that all the uproar could have been avoided if the government had done a better job communicating how the changes would affect services. With KanCare, people are supposed to be able to keep their case managers and reimbursements to agencies are to stay the same. Kansas officials say  that their plan calls for a “high level of oversight and stringent contractual requirements,” including withholding 3 to 5 percent of payments to the companies as a safeguard about meeting requirements. The changes will mean that people’s care is better coordinated and that funds will be saved due to “fewer hospitalizations and medical costs.”

Therein lies the very reasons that families are worried. “Better coordinating care” sounds great but what really matters to families is how actual care workers will handle the day-to-day needs of a loved one.

Criticism of Kansas’ Privitization of Care for Individuals with Disabilities

Hospitals and some providers have recently been criticizing KanCare for improperly denying or delaying reimbursements and creating “serious financial and bureaucratic obstacles.” Service providers in Kansas — especially smaller providers and mom-and-pop operations — are afraid this could happen to them; if it did, they would have to stop operating.

Last week, members of the National Council on Disability (which is appointed by the President) grilled Kansas state officials about KanCare. Contrary to what they claim, individuals with disabilities including Finn Bullers, a former reporter for the Kansas City Star who has muscular dystrophy and diabetes and uses a respiratory 24 hours a day and a wheelchair, report that they are seeing life-changing cutbacks to their services under the new plan.

63-year-old Kay Soltz’s 32-year-old son, Zachary, is “in constant motion, has autism and intellectual disability”; he attends a day program and lives in a single-family home with a caregiver. KanCare initially assigned a pediatrician as his primary care doctor. After Soltz objected, he was assigned to a doctor 20 miles away; Soltz then had to go through “more hoops” to find him another doctor.

“Keeping It Local” is Crucial

Very few states (Michigan, Vermont) have turned to managed care for long-term services for individuals with developmental disabilities. Most states provide these through, as Disability Scoop says, “existing networks of community-based nonprofits or county agencies”; in some cases, the states have themselves been the managed care organizations. “Keeping it local” is key for the long term care for individuals with developmental disabilities, many of whom have extremely complex needs and minimal or no means to communicate these.

Management of prisons has been increasingly passed on to private companies, with highly dubious results regarding the treatment of prisoners. For the same reasons, the care of individuals with developmental disabilities cannot just be turned over to whoever who will do it most “efficiently.”

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68 comments

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3:55PM PST on Dec 27, 2013

ty

4:26AM PST on Dec 15, 2013

ty

7:35AM PST on Dec 14, 2013

Just another step towards building a master race. Let's throw all the minorities in jail, take away any rights women may have, and kill off the elderly, infirm, and disabled. The American Dream: white men enjoying its resources, playing golf, and drinking martinis (until a more intelligent race moves in).

4:36AM PST on Dec 14, 2013

Very sad. Thanks for sharing.

3:29AM PST on Dec 14, 2013

thank you for sharing this

9:14PM PST on Dec 13, 2013

If this is what you want for your parents, siblings, wife or husband, then by all means: go to it and enrich the pillaging insurers at the same time! Never forget that privatisation starts where community stops. Get it?

For the wealthy, this isn't a problem; for the other 90% of us we rely on the care given us in our declining years by others, not necessarily family or relatives.

In ancient Rome the fire companies were all private; a system of neighbourhood alarm bells told them where to go, and when say three companies arrived on the scene, they began to bid for their services.

But it was what we now call a 'Dutch auction' in which the price keeps going down until the seller [the house owner in this case] says "Stop!" as he can't wait any longer. The point is: just how long are you going to wait while your most valuable assets are destroyed so that you can get 'the best price'? what are your parents and children worth? do you want this experiment to take place so you can find out? Even if they are left more damaged than before, just as the burning house's best price is 'Zero' when there's nothing left.

The people who do not learn from history are doomed to repeat it, even unto death & sorrow....

9:06PM PST on Dec 13, 2013

Anne M and Ron G are quite correct: this is a privatisation disaster waiting to blow up in the State's face: its citizens. I'm a USA ex-pat: @ age 26 in 1969, I left a thriving business to my employees and moved to BC, Canada, best move I ever made. As bad as it was then, it's now ten times worse, and going to get a LOT more so in the USA. The Obamacare fiasco was designed by & for private insurance companies to better their profits by firstly rounding up as many plebs as possible, then secondly getting the feds to pay the private rates the companies set! Hitler would have been astounded that We, the Sheeple, were such blind, ignorant pushovers for this set-up.

We went through the same duplicity here in BC several years ago when the provincial gubbmint said it 'had' to privatise both the facilities and the employees to have enough funds to ensure that all clients got the level of care they were accustomed to previously. In a few years families and individuals were suing because their relatives had died, been killed, or injured by the incompetents hired to replace trained union workers, and the shoddy supply services made many more people sick or increased their malnutrition.

If this is what you want for your parents, siblings, wife or husband, then by all means: go to it and enrich the pillaging insurers at the same time! Never forget that privatisation starts where community stops. Get it? For the wealthy, this isn't a problem; for the other 90% of us we re

8:06PM PST on Dec 13, 2013

ty

8:01PM PST on Dec 13, 2013

2014,, more crap, more environmental disasters, more nonsense from the government, more money for big corp., more climate change, more of the same.....

7:57PM PST on Dec 13, 2013

This totally speaking in Political context:
This is the treatment, the State of Kansas' humane treatment, in comparison to their political view on forcing the end of abortion on humane reasons? This shows their words are ridiculous in Kansas. They could care less about people or kids or women's rights or anything humane. They care about pushing religious doctrine and unsubstantiated doctrine at that. Where is the State of Kansas here? Where are the religions they practice in Kansas that allows inhumanity to exist? Yet they throw out their chest and words like they were Gods. So much for religion or the word of the State of Kansas. Sorry to those people of Kansas who do care but are lost in their State's rhetoric and false prophecies. There are caring people everywhere and they are needed to yell loudly to create effective change. In minorities as caring people, you must be the squeaky wheel because once that wheel gets the oil it's all downhill from there. This article exemplifies what's wrong with the GOP approach to education, and abortion, and management of anything. "Outsourced to run Medicaid" by the State smells of who is robbing the till. They also don't want the ACA expansion of Medicaid and that tells me they are afraid of being audited or they are just in things for the political gains. It certainly isn't to follow through for humanitarian reasons. That is obvious. No spin possible here.

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