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: KDHE News Release, 1/17/14)
Amendment Approval Letter (link no longer available 1/30/14)
Amended Special Terms and Conditions (link no longer avilable 1/30/14)
Waiver Authority (link no longer available)
Expenditure Authority (link no longer available)
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, link no longer available (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, link no longer available (Submitted 12/31/2014)
I/DD Program Renewal Application, link no longer available (Submitted 12/31/2014)
Physical Disability Program Renewal Application, link no longer available (Submitted 12/31/2014)
TBI Program Renewal Application, link no longer available (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:
The report also provides data relevant to the delivery of LTSS in either institutional or HCBS settings:
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)
On July 31, 2017, the Kansas Department of Health and Environment (KDHE) released a request for a one-year extension of the state’s 1115 demonstration, DSRIP pool, and uncompensated care (UC) pool, from January 1, 2018 through December 31, 2018. The current waiver expires on December 31, 2017. Kansas’ Medicaid managed care program, KanCare, includes LTSS services. (Source: KS 1115 Waiver Extension Application 7/31/2017)
On October 16, 2017, Modern Healthcare reported that CMS has approved a temporary 12-month extension of Kansas’ comprehensive 1115(a) demonstration waiver, KanCare. KanCare provides statewide Medicaid managed care to nearly all populations, including LTSS. Kansas must continue to illustrate progress with the states corrective action plan issued by CMS in May 2017. During the extension, the state also will continue to receive Delivery System Reform Incentive Payment (DSRIP) and Uncompensated Care (UC) pool funding, which comes to approximately $80 million per year. (Source: Modern Healthcare 10/16/2017; CMS Approval Letter 10/13/2017)
On November 2, 2017, Kansas released a request for proposals (RFP) to procure MCOs for KanCare 2.0, with contracts beginning January 1, 2019, and running through December 31, 2023. KanCare 2.0 will continue to enroll nearly all Medicaid recipients as well as all CHIP beneficiaries in managed care, and provides services across the continuum of physical and behavioral health, as well as LTSS. MCO respondents will be required to submit proposals that cover all regions of the state, all populations, and all services. Kansas is also seeking MCOs with innovative strategies to address social determinants of health, value based purchasing (VBP), and increasing access to housing and employment opportunities. Currently the state contracts with three MCOs, Centene, UnitedHealthcare, and Amerigroup (Anthem). Proposals are due January 5, 2018. (Source: RFP 11/2/2017; HMA Weekly Roundup 11/8/2017)
On November 20, 2017, KCUR reported on a series of public hearings to solicit feedback, suggestions, and concerns regarding the next iteration of Kansas’ comprehensive 1115 demonstration waiver, KanCare 2.0, which covers nearly all of the state’s Medicaid population, including LTSS. The state aims to make some improvements to the existing KanCare program. Kansas hopes to implement KanCare 2.0 beginning January 1, 2019, which will immediately precede a state gubernatorial election; some candidates have criticized the KanCare system and have expressed openness to moving the state back to a FFS or nonprofit system. (Source: KCUR 11/20/2017)
On January 22, 2018, KCUR reported on ongoing deliberations between the Kansas legislature and the governor’s office over submission of the state’s KanCare 2.0 application, which provides Medicaid managed care to over 420,000 beneficiaries. Kansas’ application would extend the program for an additional five years, and also included new work requirements and lifetime benefit caps provisions. Both houses of the legislature introduced bills that would prohibit the administration from moving forward with KanCare 2.0, but these bills are only likely to be used if negotiations between the administration and the legislature breakdown. On January 24, the Topeka Capital-Journal reported that the administration would no longer move forward with its’ KanCare 2.0 application and would instead either 1) extend contracts with current MCOs for an additional three years, or 2) remove controversial components of the KanCare 2.0 application. Kansas currently contracts with Amerigroup, Sunflower Health Plan, and UnitedHealthcare for operation of the KanCare program.
Further complicating matters, on January 25, 2018, Kansas Governor Sam Brownback announced he will resign, effective January 31, 2018, to take an ambassadorship in the Trump administration. His replacement, Lt. Governor Jeff Coyler, has been the point-person for the administration on the KanCare system. (Source: KCUR 1/22/2018; Topeka Capital-Journal 1/24/2018; Topeka Capital-Journal 1/25/2018.
Sunflower State Health Plan and United Healthcare are incumbent plans, while Aetna is newly selected. Amerigroup, as the third incumbent plan, was not awarded a contract but has stated that they intend to contest the loss of their contract through formal processes. According to the Kansas City Star, a law firm has filed an open-records request on behalf of Amerigroup, looking for additional information regarding the state’s RFP process. (Source: WIBW News 6/22/2018; Kansas City Star 6/25/2018)
On August 13, 2018, Shawnee County District Judge Franklin Theis denied Amerigroup’s request for a temporary injunction to block Kansas from implementing newly awarded Medicaid managed care contracts. Amerigroup sued the state after losing the state’s RFP for the new KanCare contract, alleging unfair treatment and lack of equal consideration. Although he denied the request for an injunction, Judge Theis did order a hearing to consider flaws in the bidding process. Following this hearing, on October 12, 2018, the judge ruled that there was no evidence to support accusations of misconduct in the bidding process and that KanCare’s new contracts could go forward as planned. KanCare will move forward with three contracts: Aetna, Sunflower State Health Plan (a division of Centene) and UnitedHealthCare. (Sources: Kansas City Star 10-12-2018 and HMA Weekly Roundup, 8-22-2018)
The Kansas Department for Aging and Disability Services (KDADS) announced they will be submitting an extension for the current Intellectual/Developmental Disability (I/DD) waiver to CMS to allow more time for stakeholder feedback. The I/DD waiver is scheduled to renew July 1, 2019. The Frail Elderly (FE) and Physical Disability (PD) waivers are currently scheduled to renew January 1, 2020. Enrollees in all three waivers are served by Kancare, Kansas’ MLTSS program which has been in operation since January 2014.
(Source: KDADS HCBS Waiver Extension Request ; 6-10-2019)
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, link no longer available; CMS Health Home Proposal Status website, 6/2014; Health Home SPA Proposal, link no longer available 9/12/2013)
On February 24, 2014, the state announced it will begin implementing Health Homes on July 1, 2014. (Source: KanCare Advisor, link no longer available 2/24/14). As of June 2014, the state is still planning to implement Health Homes in July 2014. (State Health Homes Herald, link no longer available 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)
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)