Monday, October 20, 2014

Medicaid woes highlight coverage gap

By DYLAN LYSEN, Herald Staff Writer | 4/4/2014

The state should expand Medicaid, Leslea Rockers said, because she works with several people, especially men, who are “left in a lurch” without it.

“I’ve had a lot of calls from people who want to know if they are eligible for the [Affordable Care Act] marketplace insurance, who, because of income, aren’t eligible,” Rockers, special projects coordinator at East Central Kansas Aging and Disability Recourse Center, 117 S. Main St., Ottawa, said. “And because Kansas didn’t expand Medicaid [when the federal Affordable Care Act was enacted], they are left in a huge gap of not having health insurance coverage, because they don’t qualify for Medicaid for some reason, and they also don’t have enough income to pay for health insurance. So they are exempt from the penalties on the marketplace, but they also don’t get coverage.”

The state should expand Medicaid, Leslea Rockers said, because she works with several people, especially men, who are “left in a lurch” without it.

“I’ve had a lot of calls from people who want to know if they are eligible for the [Affordable Care Act] marketplace insurance, who, because of income, aren’t eligible,” Rockers, special projects coordinator at East Central Kansas Aging and Disability Recourse Center, 117 S. Main St., Ottawa, said. “And because Kansas didn’t expand Medicaid [when the federal Affordable Care Act was enacted], they are left in a huge gap of not having health insurance coverage, because they don’t qualify for Medicaid for some reason, and they also don’t have enough income to pay for health insurance. So they are exempt from the penalties on the marketplace, but they also don’t get coverage.”

While some men already are left without health insurance, the state is on its way to limiting the reach of Medicaid within Kansas’ borders.

The Kansas Senate approved House Bill 2552 with a 33-7 vote March 25, which would allow the state to deny the expansion of Medicaid unless the Legislature signed off on it. The bill came the same week the House voted to approve a bill that would allow the state to join the Interstate Healthcare Compact, and gives the state the right to regulate health care services within its borders without federal interference.

Medicaid offers health care to people who are in need or are disabled. Supporters note that an expansion of Medicaid would help thousands of poor, working Kansans and that the federal government promises to pick up most of the cost, according to the Associated Press.

Though the House bill had been amended by the Senate, state Sen. Caryn Tyson, R-Parker, said, its original purpose was to put pressure on the Kansas Medical Assistance Program and managed care organizations in Kansas that were not promptly paying Kansas residents. The bill stipulated any contract between the Kansas Medical Assistance Program and any managed care organization would require the allowed amount on all “clean claims” to be fully paid or denied within 30 days after receipt, and the allowed amount on all other claims be fully paid or denied within 90 days of receipt.

“We’ve had problems with constituents getting prompt pay from KanCare,” Tyson said. “So the bill itself is good.”

The Senate-amended bill allows the state to limit the power of the Affordable Care Act, or Obamacare.

“The amendment was to restrict Obamacare in Kansas,” Tyson said.

Expanding Medicaid in Kansas would be costly, and the state would need to pay at least some part of it, Tyson said. The senator didn’t know the exact amount or how much the federal government would be willing to pay for the expansion, she said, although she is looking into the matter.

Many people with whom Rockers works have not been able to find health insurance because they either don’t have enough income to pay for health insurance, or because they don’t have the medical problems that the state demands before it will help with Medicaid, she said.

The Senate’s decision to deny expansion of Medicaid pushes the problem to the county level, Rockers said, which in turn is pushed to another lower level until it reaches the community trying to sustain itself. Rockers said it’s only a matter of pushing the problem off to someone else until everyone decides something should have been done.

“I think we should have expanded Medicaid. I think as a state we should have expanded it,” Rockers said. “We have too many people in need and we need to do all we can to take care of those who we can. It’s a needed service and we should be doing it.”

While state legislators are working to limit Medicaid’s reach in the state, the Kansas Department for Aging and Disability Services announced Wednesday the expansion of the Program for All-Inclusive Care for the Elderly (PACE) from serving eight counties to 59, and will begin serving northeast counties in 2015, including Anderson, Coffey, Franklin, Johnson, Linn and Miami counties, which will be provided by Via Christi.

Until Wednesday, the Kansas PACE program was available only to consumers in Sedgwick, Shawnee, Douglas, Jackson, Jefferson, Osage, Pottawatomie and Wabaunsee counties, serving about 377 consumers. Thirty-one states have PACE programs, with more than 25,000 participants in 103 PACE programs nationwide, according to the release.

Shawn Sullivan, Kansas Department for Aging and Disability Services secretary, said the expansion of a program provides community-based services and care to the elderly as an alternative to traditional Medicare and Medicaid services, including primary medical care, hospital care, medical specialty services and prescription drugs, among other services.

“PACE will offer eligible individuals in our expansion counties an alternative that allows them to stay in their homes and communities,” Sullivan said. “PACE has shown it can enhance the quality of life and independence for older Kansans, maximizing the dignity of and respect for older adults while preserving and supporting their families.”

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