Dr. Wendy Perryman
2107 Henderson Rd
Garden City, KS 67846

September 27, 2012

First, Kansas Medicaid recipients had to deal with Kansas’s money being outsourced to other states. Mainly Arizona and Massachusetts. This one move put many payroll corporations out of Medicaid business. This added up to hundreds of millions of dollars of Kansas’s money being shifted away form Kansas. Now Medicaid clientele are dealing with impersonal large corporate attitude and problems in communication not only between clients but also in amongst them selves.

After, listening to one and a half hour teleconference I again have noticed some serious problems associated with services being given to the most vulnerable people. Again, the State of Kansas wants to limit the choice of vulnerable people like the physically disabled and mentally disabled to choosing between only three nationwide companies, also based in Kansas, United Healthcare, Americare Healthcare, and Sunflower Healthcare. You would be surprised how many hundreds of millions of dollars the disabled bring into this Kansas economy. According to the Topeka Capitol Journal, over 150,000 Medicaid clients and their families will be affected by this change. Approximately ten to twenty companies will be put out of business and at least 50-100 employees will lose their jobs due to this change.

The right to choose an independent living counselor, who knows a patient’s specific needs, will be taken away. With this situation the counselors will be impersonal, large corporation people who don’t care about an individual client because their focus will be rushing to meet their quota. At a public meeting held at the Clarion Inn in Garden City, Kansas to introduce these three companies, many questions were presented to the companies but could not be answered by them. An example of one question was, if they knew of the Kansas Work/Working Healthy program. None of the three were aware that this program existed. According to the individuals that ran the teleconference on August 27 the program was mentioned twice and barley mentioned at all. Many questions still remain unanswered about Kansas Work because they dropped my call. How can they help the patient if they are not aware of the individual programs within the Kansas Medicaid system?

A counselor is most effective when trust exists. How can trust be established with telephone calls and different people visiting home-based clients? These counselors would be strangers. There would be no continuity or trust in their care. The counselors would not be committed to the client because the “big picture” would focus directly on effective business. This is exactly what was presented in the KanCare presentation. In our society the most impaired people on Medicaid will not receive the needed assistance for their basic care and needs with this change to counseling. If the client is completely satisfied with their counselor, these counselors should really stay in business, or be hired by one of these three companies.

Some things we cannot assign a value to, because they are priceless, such as, the quality of the care given to a Medicaid patient during the last days of their lives.

Please take these serious concerns into consideration.

Dr. Wendy Perryman

In glancing through comments, I do not see a specific mention of the issues that the KanCare transition will cause to the most medically fragile population. These are children from age 0 thru 21 who are on the Technology Assisted Waiver who without this benefit, would be institutionalized as they are on life-saving technology. With the TA Waiver, they are able to live at home and have either nursing or attendant care to meet their medical needs, as well as allowing parents to work since most daycare facilities do not accept these complicated children. RNs and APRNs are the case managers for these clients due to their medical needs. However, the state currently does not allow them to appropriately coordinate medical care as it is considered to be a "conflict of interest", even though these were independent case managers, not affilitated any agency or Medicaid provider. However, they are asking and expecting the MCOs to do this. Over the past 4 years, the TA program manager has implemented a comprehensive assessment tool to help contain costs, while determining services based on the needs of that particular client, empowering families with responsibilty for care, but yet allowing the parents to be in the work force instead of unemployed or on welfare in order to take care of their child. In the last month, case managers have been given conflicting information as to their future since they are currently Medicaid providers, unlike case managers on other waivers. However, they have now been told that they will have to be employed by the MCOs. So - what happened to the promise to families that they would keep their case managers and that the MCOs would have to keep all the current Medicaid providers? One answer case managers were given was "it only applied to those consumers on the DD waiver". Clearly at every public meeting that was given, there was never that specification or clarification that this was for DD only. TA case managers also help and educate families on navigating the process of dealing with the complicated bureaucratic system. Now that the state has implemented changes to that in the last year that were supposed to ease that burden, it has only been worse. Families were also told that services would not be decreased, but then - in this medically fragile population, where there is very little stabilization of costs. If the case manager's "job" is to save the MCOs money, who will be the ones to watch out for the safety of these clients? Will it take something tragic happening to them because the MCOs wouldn't allow the necessary services in the home due to the cost? Unfortunately, a lot of the parents of these types of children have their own medical and mental issues, and need assistance in caring for a very complicated child, and the children are caught in the middle. What concerns me most is that with the "talking out of each side of the mouth" that has been given to providers, and families. Families and providers have been given a lot of conflicting information. How much worse is this really going to be when the transition begins before January 1st? Right now, that transition process looks very shaky and destabilizing for these kids and families if this is implemented January 1st, let alone at all. If the state would assign all Medicaid beneficiaries, whether or not they are on waivers, with Medicaid independent nurse case manager providers and allow them to actually case manage, I think they would find they would save the money they think they will save by giving contracts over to companies who have no investment in our state, but only in expanding their business. I suggest that you look at more of the details of the plan because those details seem to keep changing dependig on who is speaking. I agree that there needs to be a change to help reign in the rising costs of Medicaid. However, those that need the help the most are the ones that are going to suffer from this change as it seems to be more political than financial. Yes, some waivers need revamping in their administration of covered services, but to include those on the DD waiver, the FE Waiver, the TBI waiver, and the PD waiver into a change of this magnitude all at one time is socially irresponsibler. These are client's who can't always speak for themselves and when the administration has "public meetings" to get input from providers, but it is obvious that they are not respecting any of that input, until challenged "big time" and then only bows to that population because they are the biggest voice. So why is it that the smallest voices get lost? Maybe because it is one of the smallest waiver, but these children are in need of services that even private insurance will not cover. I may be a Republican, and I don't appreciate people getting services they don't deserve, or that they abuse, but with the safeguards that the TA waiver program manager has put into place, these children and their families only receive services that are needed to keep them as contributing members of society. Our TA Waiver has been looked at by many states to copy because of how it has been structured. Basically, it is a type of managed care already, so why destroy something that is already working and others want to model? Oh, I know - for political gain and the ability to say "I reigned in Medicaid costs", regardless of what happens to a small population. I thought everyone was important. Please don't make a rash decision and consider thoughtfully and complete the full ramifications of a change of this magnitude.

My husband and I own a small business that has struggled during the recession. In addition to our family business, I have a full time job, but we are still reliant on Healthwave to cover our three daughters' health coverage. It provides full dental coverage for them and has saved us when they've had costly health issues that would have been too expensive for us to purchase out of pocket. It has also insured that we are able to keep up with important preventative health care and dental cleanings. Healthwave has worked beautifully for us, and I see no reason to go through the costly process of changing a system that is not broken. I am also concerned about the dubious nature of the goals of the proposed changes, and the risk of benefits being lost to people who need them. Please deny this waiver.

In the past there has been a lack of communication between the departments at SRS and in our Government Offices. It would greatly benefit each individual, if their case information could be shared, with all the different departments in our State Government. I know the privacy act limits what can be shared. However actually having every department be able to share information about all Clients, would be very helpful. The different programs for Medicaid. Please let the different programs funct enrollies wouldn't duplicate services, through another program. Or not give people all the help they need, if they reach out for help. I feel the current system is inadequate for actually helping people with Disabilities receive the care and services they need. Surely the system can be improved, so everyone can receive care and all the services they actually need. There would be a lot less confusion if all Departmetns would share what they know and who it is actualy. I pray the new Medical program will have all the information about each client on Medicaid. Then there wount be any people cheating on what their needs are and how they are being cared for. Each department could get a better quality service for all involvedl

About all a Person with Disabilities can afford to live in is Public Housing, or a very low rent apartment. An individual isn't allowed to rent a 2 bedroom house, if they are single with no children. Our Government should give people vouchers for rent and let them pick where they want to live. After all our Federal Government actually puts almost $2,000 per month into their housing programs, for each individual with Disabilities. The funds don't trickle down to those who are suppose to receive them. Most of the $2,000 gets used up in overhead and management of the Housing Programs HUD. For petes sake, just give each person the $2,000 per month and let them pick where they want to live and how large a place they want to live in. Don't restrict Poeple who are single and without kids, to a one bedroom apartment. Many of the 1 bedroom apartments are almost worse than living on the street, or under a bridge. Living in a 1 bedroom apartment, is like you are shut in a small box. As far as I'm concerend, I feel living in the restrictive tiny 1 bedroom apartment, is crule and inhuman punishment to many people. You shoud go look at some of the tiny apartments people are forced to live in here in Wichita. Also many of the local apartments are over run with rodents and bugs, with utilities that don't function correctly. Housing for Poeple with Disabilites, that is quality, instead of a Nursing Home, should be a covered cost for KanCare.

Our States Dr's, need to change their tactics, as far as prescriptions for People with Disabilities. Most People with Disabilities I know, are on 10 or more medications. This causes terrible side effects in their bodies. Also it incapacitates most of them. This is not treating a Person with Disabilities with Respect and Dignity. Many People are on pain medications and other mind altering drugs, that make it almost impossible for them to function with any quality of life. It's time People with Disabilities were given Food supplements, vitamins, nourishing foods and other natural products, instead of all the prescription drugs. They would be much healthier and it would cost our State much less for their care. For instance, vitamin B 12 is one of our bodies natural pain fighters. Instead of using Mind altering drugs for pain, I receive a 2 ML inj of Vitamin B12 per week. It's much better than not being able to think clearly. Also the mind altering pain medications and muscle relaxers, are adictive. The longer you take them, the more your body requires. Wouldn't it be better to give a person a 2ML vitamin B12 injection each week, than put them on Fentenal Trans Dermal Patches, Oxycotton or Loratab? Therr are certain basic nutrients all our bodies need to heal theirselves. It's time those kind of Products are given to people, instead of just medicating them to shut them up, because the Dr's cant' fix them and don't want to listen to their complaints, or be burdened with them. After all we aren't really broken, God made us the way we are. It's time our State recognised that each one of us has a right to a quality life. We should be given things that inhance our abilities, instead of restriciting our abilities from being over medicated.

Please end the Wait for those who are in need of HCBS Services? People that have been on the waiting list for HCBS Services, should all receive services right away. There have been people in our State who have died, without receiving HCBS Services, while on the States Waiting Lists. There shouldn't be anyone on a waiting list for services. Our Federal Government requires that All People with Disabilities be allowed to live in the lest restrictive environment, that gives them the best quality of life their Disability allows. People shouldn't just be stuck in the Nursing Homes as it costs 3 times as much for Nursing Home care verses HCBS Services. Or be left for their families to care for them. Care for People with Disabiliities is very costly. Most families can't afford all the things that are necessary, for their Loved ones with Disabilities to have the best quality of life possible

I truly believe that if you would cover the cost of Food Supplements such as Protandim and Ambrotos, you would have more People with better health. People with better health, have a better quality of life and it costs less for their care. I used to be on over 24 medications, which cost the Medicaid Program over $2,000 a month for my prescriptions alone. Now that I take Food Supplements Protandim and Ambrotos, I only cost the State a few hundred dollars a month for Prescriptions. Also I have changed from being a Zombie in an electric wheelcahir, to not even needing a walker to get around. I have a much better quality of life. With fewer Dr visits and lower cost to our State.

We should not in any way privatize a program that is there to help our citizens that do not have access to healthcare because of lack of funds. A private company is interested in one thing: money. Companies do not have the interest of people at all in mind unless those people will increase their stock prices and profit. The answer is not privatization. Our current governor and state government should stop trying to destroying public and social safety nets and find true solutions that actually help Kansas citizens. That includes the poor and lower income citizens also, not just the rich citizens and companies that dump money into the governors coffers.

He has been approached by managed care people who have told him that he would be reimbursed at approximately 50% more with KanCare than with Medicaid, IF: He agrees to see new patients - not if he simply continues to see the few patients he already has; if he agrees to change his pattern of treatment to "behavioral therapy" which is based on shaming patients into setting goals that don't work (goals don't work, behavior modification doesn't work and in the end patient and caregiver alike are made to feel that they have failed); if he agrees to changes in medication suggested by managed care to the extent that the in some cases the patient's well-being is threatened. Managed care is a system by which people are essentially herded to particular sites when those sites need more patient appointments. The feasibility of transport for many of the people who would be controlled by managed care is not a consideration. The appointments are made well in advance because that's when the openings exist. They appointments are so far in the future that by the time they roll around, they are missed, forgotten, no longer needed, or they occur on a day that won't work for the patient for any number of reasons. When the appointment time becomes available, people on a waiting list are offered the time (often just hours before the appointment time). When the patient is unable to take the time offered, they are out of luck because they did not take advantage of the time they could have had. Managed care makes its money hassling the providers who have signed a contract. Managed care is driven by the bottom line, making money without concern for the care of the individual patient. They do not have any incentive whatsoever to attend to the needs of the people they will control. No incentive at all. None. Managed care has people who have training in allowing only what has been determined to be cost effective. Managed care people are not in the business of providing the appropriate care, just the least costly attention.

Before any action is taken on the Federal level in the process of deciding whether or not to allow the governor of Kansas to push this plan through, it is vital (literally) that the exact procedures and intentions be fully available for complete unbiased review. If there is nothing in the promises made that threatens the adequate state of the art care for those people who need it, there should be no hesitation to provide that information.

For the sake of the people of Kansas who do fall into the 47% defined by the republican candidate for president, I ask that Health and Human Services decision makers insist on complete and unambiguous access to any and all contracts, guidelines, procedures, training courses, provider documentation, provider reimbursement tables, and all planned extras such as uncompensated care costs, alternatives to Medicaid, and actual amounts covered listed by service. This will be huge and it will be convoluted but that's how people who run such businesses make their money. They hide in plain site all the ins and outs except for the straightforward answer to how much something costs and who pays for it and who will be allowed to have it. We all know this from recent financial disasters and from the obvious lack of intent or maybe ability of those who are or will be in charge to provide the facts as they stand.

Please don't let the people with personal agendas in Kansas destroy what is working now for our people who have nowhere else to turn. And please don't make people who take care of these patients for the small amount of reimbursement they already are forced to accept, please don't require them to go out of business or to adjust to the lowered income that will result causing loss of jobs that we so need.

The private sector is far better at managing programs. If you do not believe it, look at the huge waste in almost every government run agency and how it is almost impossible to control it. Government manager’s pay grade is based on how big a budget they manage and the number of people they supervise. If you ask what they need, the answer is always “MORE”. Don’t believe it? Ask any Federal bureaucrat about “mission creep”. Simple stated, once a small, temporary program gets approved, it quickly grows and morphs into something huge with functions that often overlap existing programs or function that really are not the role of government. Let’s approve the wavier for KanCare and take a step towards reigning in at least one bureaucracy.

LeadingAge Kansas represents 160 faith-based and other not-for-profit organizations that collectively serve more than 20,000 older Kansans everyday through their nursing homes, retirement communities, hospital long-term care units, assisted living and residential health care residences, homes plus, low income housing, licensed home health agencies and other community based service programs.
We support Medicaid policy that is focused on quality outcomes, consumer choice and increased care coordination for individuals across health care settings. KanCare is the Administration’s attempt to bend the Medicaid cost curve while improving care coordination and health outcomes. If the waiver is approved and KanCare implemented, LeadingAge Kansas stands ready to assist the State to achieve those goals.
Ninety eight percent of our members participate in the Medicaid program. In SFY 2011 LeadingAge Kansas members provided nearly 1.5 million days of Medicaid-funded nursing home care. More than 15% of the assisted living care they provided was funded by the Medicaid program.
For almost two years we have closely followed the State’s development of KanCare. We appreciate the numerous opportunities we have had to ask questions and provide input to State officials along the way.
Legitimate concerns remain.
Timeline and Readiness
We are increasingly uncertain whether January 2013 will provide sufficient time for the necessary parties (i.e. state agencies, MCOs, consumers and providers) to be ready for a successful launch of KanCare.
The original timeline for the launch of KanCare was very ambitious. While we appreciate that the state has contracted with an outside firm to assess whether each MCO and the state is prepared for a January launch, it is equally important to assess whether consumer education efforts underway are adequately preparing beneficiaries.
The state approval of MCO contracts and provider manuals has taken significantly longer than projected, severely compressing the time available for providers to review contracts and to have their questions and concerns addressed. Providers are now being pressured by MCOs to sign contracts in an unreasonable period of time or risk being punished for missing an overly ambitious deadline.
Lack of Operational Details
The lack of specific answers concerning how KanCare will actually operate may make a January launch difficult and rocky. There are hundreds of unanswered questions on billing procedures, policy manuals, care managers and coordination, record keeping, quality tracking, credentialing, and community based service capacity. With less than four months until launch, we find this lack of details troublesome.
Auto-Assignment and Consumer Education Concerns
We believe beneficiaries should be able to choose their health plan upon enrollment, rather than being auto-assigned by the State. Short of that, beneficiaries should have at least 90 days, rather than 45 days, to change plans.
KanCare providers will be serving as the state’s de facto consumer educators for many beneficiaries. This must be acknowledged and the state should equip providers with appropriate tools and information to help assure beneficiaries have access to information about KanCare in real time, at the right time, in the place they call home.
Medicaid Program Savings under KanCare
The State has ambitiously projected an $853 million dollar savings to the Medicaid program over 5 years with KanCare. What happens to providers and consumers if those savings are not realized? If the savings do materialize, how will those funds be used? Our strong recommendation is that any savings should be reinvested to improve service access, quality and options for Medicaid beneficiaries.
The Real Problem Remains Unaddressed by KanCare
KanCare and the various managed care and other experiments underway in our country do not touch the real problem that is driving Medicaid spending. As long as Medicaid is the default long term care insurance program for the vast majority of Americans, and as long as hardworking middle class Americans are forced to spend themselves into poverty in order to pay for their long term care needs, Medicaid will continue to grow at an unsustainable rate.