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
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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