Thursday, 02 February 2012 10:40
By Tom Racunas
This past November, the Executive Branch of our Kansas government announced plans to implement a new system for how Medicaid services are delivered and reimbursed, called KanKare. This decision follows the trend that most states have made in an attempt to improve care and reduce costs. Three billion dollars will soon be managed by three private, for-profit, out-of-state insurance companies.
Unlike most other states, however, the new KanKare system includes the provision that long-term care services for people with disabilities, including those with intellectual and developmental disabilities and the elderly, will also be managed by these insurance companies. Most states have excluded services for people with developmental disabilities from these managed-care systems. (Or have “carved them out” after managed care systems didn’t work). While insurance companies may do a fair job of managing medical services, insurance company representatives admit that they have little to no experience providing long-term care services for those with significant developmental disabilities. Examples: a young man with autism who has severe, challenging and life-threatening behaviors; a young adult woman who is severely multiply disabled, has progressive health related issues and is in need of residential services because her parents are ailing or an older adult with intellectual disabilities and mental illness. These are not random examples. These are three examples of Catholics and their families who live in the Diocese of Wichita.
At a community meeting held recently in Wichita, Shawn Sullivan, Secretary of the Department of Aging, spoke to people with developmental disabilities, their families, caregivers, and representatives from agencies which coordinate and provide services. With sincerity, he tried to alleviate some of the fears that have been expressed regarding the upheaval that this change may cause. Specifically, Secretary Sullivan, stated that people with developmental disabilities could keep their current case manager if they so choose, that services and reimbursement rates won’t be cut, and that service agencies will be able apply to be a provider with one of the managed-care companies. But many critical questions still need responses. To name a few:
• How will cost savings be realized if many provisions of the current system are to remain the same?
• How will managed care affect the recruitment, training, and retention of direct care staff and, more importantly, the overall quality of care?
• How will the KanKare system impact the nearly 4,500 Kansans with developmental disabilities who are on a waiting list for services?
• Most significantly, how will managed care impact choice in services and supports that persons served and families have come to value as a meaningful testament to their dignity as a person regardless of the nature or severity of their disability?
The current system of services created by the Developmental Disabilities Reform Act (1996) is a form of a managed care system. A good managed care system. Services are funded, coordinated, and reviewed for quality by a Community Developmental Disability Organization (CDDO). Persons with disabilities and their families have choice about where to live, where to work, how to spend leisure time—choices that enhance quality of life--choice that demonstrates a respect for the dignity of the person.
The questions are complex and the answers are even more so. Yet, are not the most vulnerable of our brothers and sisters worth the time and energy to insure that any systems change should be implemented without causing undue stress and increasing the risk for harm?
State Senator Dick Kelsey (R-Goddard) thinks so. At a public meeting of the Senate Public Health and Welfare committee, Kelsey said that the plan is moving too fast and has the possibility of seeing breakdowns in services for those who require long term care.
Decision makers need to be encouraged to “carve out” the services for the developmentally disabled from the KanKare system at this point in time. Representative Jim Ward (D-Wichita) has introduced legislation to try to do just that. Let the new system take hold. (It will be challenge enough to implement for all other Medicaid services). See how it works. Iron out the kinks. Then, begin to consider, with meaningful stakeholder input, if and how services to those with developmental disabilities can best be served within a system that, hopefully, will have demonstrated a good deal of success, credibility, and trust.
Be that encouragement! Contact your local legislator to let them know of your concerns and ask them to lend their voices to yours to insure that our most vulnerable brothers and sisters are cared for properly.
(For more information, go to the diocesan website, http://catholicdioceseofwichita.org/. Click on Offices and Ministries. Click on Persons with Disabilities. Click on the link on the homepage.)
Racunas is the director of the diocesan Ministry with Persons with Disabilities.