A 'Grand Experiment'

The "Grand Experiment" in social services continues. This past Tuesday, Gov. Brownback announced sweeping reforms to the state's Medicaid system, that according to Lt. Gov. Jeff Colyer, will save the state $367 million over the next five years without cutting rates or services, this while at the same time improving the quality of services provided.

Their plan involves reshuffling departments, implementing a global waiver, expanding managed care to all Home and Community Based Services (HCBS) programs, emphasizing "health homes," intensive case management and improving efficiencies within departments.

While I applaud the governor in his attempt to get Medicaid costs under control and support a couple of the initiatives, some of the "new" initiatives already exist in our current system and have been very effective in controlling costs.

In fact, the developmental disability field led the charge to bring managed care to our system back in 1995 when the Developmental Disability Reform Act was passed by the Kansas Legislature. It created Community Developmental Disability Organizations (CDDO), whose purpose it is to manage a capitated funding structure, provide quality oversight, do eligibility determinations (assessments), referrals, provide a stakeholder council, etc., all classic examples of locally designed and controlled managed care.

The main goal for the state is to save money. You will hear from them that managed care will do just that, but the fact is that a new managed care model for Developmental Disability Services will not save the state any money. Currently, the CDDO's cost the state 2.4 percent of the DD system funding. Out-of-state managed care companies take anywhere from 5-20 percent cut. They are in business for profit, not to care for people.

If a new managed care company came to Kansas, the cost to provide this service would be approximately $75 million off of the top, which means $75 million less for the people of Kansas. In fact, the state's most recent attempt to utilize managed care for the non-emergency medical transportation (NEMT) waiver created such a debacle that TVDS no longer provides this service.

This was due to a drop in rates, a change in eligibility criteria and the confusion of dealing with a large out-of-state entity that has no idea about transportation in a rural setting.

The St. Louis Business Journal recently featured Medical Transportation Management (MTM), the managed care company for NEMT, and it noted how MTM doubled their profits from $68 million in 2009 to $130 million in 2011, expanded their square footage by 14,000 square feet and grew by 174 employees over the past six months.

It is nice to see Kansas tax dollars and jobs going out of state and the same thing will happen with an out of state managed care company who will oversee our services.

You will also hear from the state that the growth in the Medicaid Waiver (HCBS/DD) is due to the cost of service delivery. That is not the case. The number of persons and families served by HCBS since 2000 has increased 2,781 or 53 percent, while growth in rates paid has increased at about one half the rate of inflation since 1993. You also have to remember that there are currently over 4,000 people on the statewide waiting list for services.

In addition to managed care, "health homes" and intensive case management already exist in the current system to provide holistic care for the people we serve and to provide care coordination across providers. This includes an RN on staff, appointment clerks, and others who in coordination with parents or guardians, oversee the health of the people we serve. This is in addition to the day, residential, and employment services we already provide.

It is my hope that it is not the governor's intent to use the proposed savings from Medicaid Reform to eliminate the Kansas income tax when their own studies indicate that we are being underfunded from the state already. It has become a sad reality that we are returning to a time in our history that I would soon forget, a time when people with disabilities were crammed into housing or facilities, options were limited and they were forgotten about, all because of a "Grand Experiment" in social services went wrong.

Editor's Note: Tim Cunningham is the executive director of Tri-Valley Developmental Services, which serves developmentally disabled people in Allen, Bourbon, Neosho and Woodson counties.