The disclosure of a highly critical federal review of Kansas’ Medicaid program provoked bipartisan fury among lawmakers on Thursday, who said they were blindsided and not informed of the troubling findings.
Lt. Gov. Jeff Colyer said the report amounted to a politically-motivated attack against Gov. Sam Brownback.
Republicans and Democrats voiced anger with Brownback’s administration over two letters from the Centers for Medicare and Medicaid Services sent to the state this month that detail significant problems with KanCare, the privatized system that covers more than 400,000 individuals, substantiated during an October review.
Lawmakers said they hadn’t been informed of either communication. One Republican committee chairwoman announced she has summoned a Brownback cabinet secretary to appear before lawmakers next week.
The administration said the recent audit contains no fresh revelations about KanCare. Kansas received a preliminary audit report in November, a statement said, and the state had begun to address the issues found.
“I wish I would have known about this,” Hawkins said. “I’ve got members coming to me, saying ‘What are we going to do? I need talking points.’ I don’t have any information yet.”
An October on-site review of KanCare conducted by CMS found the program is “substantively out of compliance” with U.S. law and regulations. One letter sought to “underscore the serious nature of these concerns and the risks it poses to beneficiaries.”
The Jan. 17 letter denied a request to extend a waiver — known as a section 1115 waiver — authorizing the KanCare program by a year, from the end of 2017 until the end of 2018. Kansas must formulate and implement a corrective action plan, CMS officials say.
The federal review found insufficient oversight and flimsy annual reports about the program. Sean Gatewood, a spokesman for the KanCare Advocates Network, said the Legislature had been flying blind in attempting to provide oversight because the state hadn’t been providing adequate information.
Senate Minority Leader Anthony Hensley, D-Topeka, called KanCare “fatally flawed, deeply in trouble.” He said lawmakers must hold Lt. Gov. Jeff Colyer, who spearheaded the launch of the program in 2013, accountable.
“This is the strongest indictment against a state Medicaid program, and confirms the problems that advocacy groups and constituents have told us about for the past several years,” Hensley said. “The Brownback/Colyer political spin has gone on for far too long. It is time for this administration to stop making things seem better than they really are. Kansans deserve the truth.”
Sen. Vicki Schmidt, R-Topeka, and the Senate Public Health and Welfare Committee chairwoman, said she was deeply concerned over the finding by federal officials that KanCare was substantively out of compliance with federal law and regulations. A stack of print-outs of the original Topeka Capital-Journal story on the federal review sat next the entrance of the committee room Thursday and she urged lawmakers to read it.
Schmidt said Kansas Department of Health and Environment Secretary Susan Mosier will appear before the committee on Monday to answer questions. In a statement, Mosier argued Kansas was treated differently than the other 11 states who applied for a program waiver extension.
KanCare reform legislation circulating in the Statehouse would require the managed care organizations to provide accurate data on patients, require quarterly education by MCOs to providers on billing, reimbursement and other policies, and caps administrative spending by MCOs at 10 percent of total expenditures.
The disclosure of the letters from CMS come the same week Republican Donald Trump is set to become president. His administration, along with a Republican-controlled Congress, may seek changes to Medicaid, potentially providing additional leeway to states to run their programs as they see fit.
Colyer was in Washington, D.C., on Thursday, speaking with Republican U.S. senators about the future of Medicaid. According to POLITICO Pro, Colyer was joined by governors and lieutenant governors from nine other states.
In a statement, Colyer predicted the next KanCare contract will extend beyond 2025.
“This is simply an ugly parting shot from the Obama administration at Gov. Brownback on their way out the door,” Colyer said. “It is politically motivated pure and simple, and we expect this situation to be resolved quickly once the new administration in Washington comes into office.”
Sen. Laura Kelly, D-Topeka, expressed relief the federal government had finally sanctioned KanCare. She also acknowledged the incoming Trump administration looms over the situation.
“I understand that, but better late than never,” Kelly said.
KanCare has been a jewel of the Brownback administration and is the biggest achievement of Colyer, who some speculate may mount a run for governor. The administration argues the program works and has offered a better alternative to Medicaid expansion.
“We have proven that a Kansas solution is better than one from Washington, D.C. KanCare is working,” Brownback said in 2016.
But advocates and Medicaid recipients had been voicing frustration throughout the past year over problems with the program. A backlog of unprocessed applications that at one point exceeded 10,000 perhaps loomed largest.
On Thursday, Gatewood said he felt vindicated.
“Yes, you better believe it,” Gatewood said. “I’ve been asking for this for years.”