TOPEKA, Kan. — Advocates say family members have been asked to accept plans of care for disabled Kansas residents under the state’s Medicaid program without knowing whether services will be cut.

The Kansas City Star reports that independent case managers in Johnson County say the program has become less collaborative and more secretive for people with disabilities since 2013. That’s when the state turned over its management to three private insurance companies.

The privatized Medicaid program, known as KanCare, covers more than 400,000 people, most of them low-income children, elderly people or pregnant women. About 20,000 Kansas residents with disabilities rely on KanCare for services such as bathing, dressing, tube feedings and catheter draining to allow them to live at home rather than in an institution.

“There is no transparency,” said Vicki Distefano, who relies on KanCare to provide in-home care her brother needs around-the-clock after a 2006 motorcycle accident left him unable to walk, talk or take care of himself.

The state promised to fix the problem in a plan it filed with the federal government following a critical audit last year. Kansas hopes federal officials grant their permission to extend the privatized Medicaid program past 2018.

Lt. Gov. Jeff Colyer, an architect of the program, said, “we listened closely to the voices of stakeholders and citizens in our effort to make KanCare even stronger.”

A Johnson County group, Families for KanCare Reform, said its survey of 235 families throughout the state that receive disability services showed that dozens had been asked to sign blank forms or forms they knew were incomplete or inaccurate.

Distefano said a state contractor who came to her Fairway home last year to show her a new care plan for her brother asked her to sign a blank iPad screen. She refused and later learned the new plan would cut his services by 62 percent. She hired an attorney and spent months battling successfully to get the cut reversed.

Kim Kass, an attorney representing Distefano, said she believes Medicaid contractors ask people to sign plans they haven’t seen “to avoid the drama” when big cuts in services are planned.

State spokeswoman Angela de Rocha said the companies running Medicaid are operating in good faith but need to be more transparent.

Miranda Steele, a spokeswoman for one of the companies, the Sunflower State Health Plan, said its own survey this year found a satisfaction rate of nearly 95 percent among people receiving disability support services. Sunflower is a subsidiary of St. Louis-based Centene Corp.

And Steele said the company’s care coordinators are trained to ask for a signature on a care plan only after it has been “fully reviewed and is final.”