TOPEKA, Kan. — Top Kansas officials expressed confidence Friday that the federal government will allow the state to overhaul its Medicaid program, but critics questioned moving ahead before securing permission.
Gov. Sam Brownback's administration has formally applied for a waiver of federal Medicaid regulations that would impede efforts to redesign the state's $2.9 billion-a-year program, which covers health care for the poor, needy and disabled. The application was submitted Thursday to the federal Centers for Medicare and Medicaid Services — a day before other, new rules changed how such requests are handled.
The conservative Republican governor plans to turn Medicaid over to three private, managed-care companies, starting Jan. 1, 2013. The administration expects to issue contracts this summer, though it has promised to delay including long-term services for the developmentally disabled in the overhaul until Jan. 1, 2014.
The federal government must approve some changes because it provides a majority of the funds for states' Medicaid programs. Kansas is asking the federal government to waive multiple rules, and Brownback's administration plans to submit a proposal later for a "global" waiver to give it even greater flexibility.
Lt. Gov. Jeff Colyer, a surgeon who led the team that developed the Medicaid overhaul plan, said Kansas is asking the federal government to waive rules that have been suspended in the past for other states. Administration officials also said they've had productive conversations with federal officials since late January, when Kansas notified the federal Medicaid oversight agency of its plans by submitting a concept paper on the overhaul.
"We think that we should get approval," Colyer said during a Statehouse news conference. "We are using standard tools that have been approved before."
The administration argues that overhauled Medicaid program — to be called KanCare — will better coordinate care for participants, improving their long-term health. The administration also projects the overhaul will reduce the state's costs.
Alper Ozinal, a spokesman for the federal centers, said it is in the "early stages" of its review. There's no formal timetable for making a decision, though state officials released a schedule anticipating federal approval of its three contracts in August.
"We will work to review the application as expeditiously as possible," Ozinal said an email to The Associated Press.
Some lawmakers have suggested delaying the overhaul, fearing that changes are coming too quickly. House Minority Leader Paul Davis, a Lawrence Democrat, said it's "perplexing" that the administration didn't hold off until the federal government was closer to approving a waiver.
Kansas Lt. Gov. Jeff Colyer answers questions from reporters during a news conference about a plan to overhaul the state's Medicaid program, Friday, April 27, 2012, at the Statehouse in Topeka, Kan. Colyer, a surgeon, led the team that developed the plan. (AP Photo/John Hanna)
"I think we have to make sure that we don't go down the road and commit resources if we don't know if the federal government will approve our waiver application," he said.
The federal oversight agency for Medicaid is part of the U.S. Department of Health and Human Services, and its secretary, Kathleen Sebelius, is a Democrat who previously served as Kansas governor.
New rules for waiver applications took effect Friday, mandated by the federal health care overhaul in 2010. The rules require a state to have two public hearings at least 20 days before submitting an application to the federal government, according to guidance supplied by the federal Medicaid oversight agency to states. There are also requirements for notifying the public, and a state also must compile a report about the comments it received and how those comments were considered before submitting an application.
Administration officials noted that Brownback's team began working on overhauling Medicaid shortly after he took office in January 2011 and had meetings around the state to solicit public comments. Town hall meetings on Medicaid are planned for July.
As for the timing of the state's formal application, Colyer said, "This is just when we got everything moving."
Most of the 387,000 Kansans receiving state medical assistance are covered by managed care through private contractors, but the Medicaid overhaul represents the first time the state has tried to include relatively expensive, long-term care for the disabled and the elderly, including those in nursing homes.
Advocates for the developmentally disabled have been vocal critics of the overhaul. Their concerns led Brownback this week to endorse a proposal to wait a year to deal with long-term services for the developmentally disabled in the contracts, while permitting pilot programs.
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Centers for Medicare and Medicaid Services: http://www.cms.gov/
Kansas governor: https://governor.ks.gov
John Hanna can be reached at http://www.twitter.com/apjdhanna