How many times have you gone out to purchase a new or used car without first looking under the hood, checking out the tires, and taking said vehicle out for at least a test drive? Pretty much never, right? That’s because you would be exposing yourself to a lot of risk (financial, personal safety, etc.) if you didn’t at least try to confirm before the purchase that the car would be able to reliably meet your particular transportation needs. Unfortunately, the Brownback administration appears determined to subject Kansas’ 380,000 + Medicaid recipients to far-reaching Medicaid reforms on January 1st of next year without first performing due diligence on the proposed changes. Given the administration’s track record at shuttering SRS offices across the state this past summer, Kansans deserve to have at least some level of confidence that the proposed reforms will deliver the intended benefits before the reforms are implemented. Otherwise, both Kansas Medicaid clients and providers could suffer greatly from unintended consequences.
Make no mistake – something needs to be done to address the spiraling costs of Medicaid that Kansas has seen over the past 10 years. Medicaid costs comprised nine percent of the State General Fund (SGF) budget for Fiscal Year 2002. Fast forward ten years later, and Medicaid now constitutes 19 % of the SGF budget. Growth in Medicaid expenditures has averaged around 7.4% a year, and that increase reflects more than just new consumers entering the system. The largest increase has been for persons with disabilities, which increased from approximately $917 million in FY 2007 to $1.16 billion in FY 2010, representing an increase of 26%. The challenge lies in determining what reforms need to be made.
Numerous Medicaid provider and consumer stakeholder groups have raised issues with the Governor’s proposed reforms, voicing concerns that the reforms may in fact not work as advertised but instead wreak havoc on the system. And other states have encountered problems in their attempts to reform Medicaid. A news article recently appeared in the Louisville Courier-Journal reporting about similar reforms that the state of Kentucky implemented on November 1st of last year and the resulting fallout. Kentucky lawmakers are now hearing from their constituents about lack of payments for medical services, challenges in getting patient medications approved and delays in authorizing services. Kentucky’s acting Medicaid commissioner told a Senate committee that “we didn’t expect the level of issues that we had”.
As Kansas embarks on reforming Medicaid, I think we should all keep in mind Hippocrates’ advice to “First Do No Harm”. At a minimum Kansas should look at implementing a limited pilot program to test out the proposed reforms and confirm the results before committing all 380,000+ clients to a new system. Otherwise, we’ll be picking up the pieces of shattered lives for years to come.