CHANUTE – Among changes Gov. Sam Brownback has proposed for delivery of services through privatization of Medicaid in Kansas is to put developmental disabilities programs under managed care.
That, he and proponents in his administration claim, will make coordination and integration of care better.
Tim Cunningham disagrees. “Don’t believe it,” he wrote in a recent letter to Tri-Valley Developmental Services clients and their families.
“The governor is looking to save over $800 million over the next five years and does anyone believe this can be achieved by ‘coordinating and integrating care?’ I don’t know of anyone who does except for the lieutenant governor (Jeff Colyer) and the governor,” Cunningham told the Register.
Cunningham, Tri-Valley director, said putting services for those with developmental disabilities under managed care, which would be provided by a huge insurance company yet to be selected, would add another layer of bureaucracy to the system.
Outsourcing the service from one managed by the state to private business will be more expensive, Cunningham said, and necessitate cuts, which can be accomplished only by reducing services or numbers of clients served.
TRI-VALLEY has 200 clients served by a staff of 152, which is 22 fewer than in 2007.
Cuts have been made several times to TVDS’s budget in recent years. It lost $980,000 between 2007 and the end of 2010, along with additional state grants for specialized services that some years amounted to more than $120,000.
The bulk of Tri-Valley’s funding, 85 percent, comes from Medicaid, which is a mix of 40 percent state money and 60 percent federal.
Tri-Valley serves Allen, Neosho, Woodson and Bourbon counties.
Funding losses have caused 34 families with children who have disabilities to be “cut free.” Tri-Valley was a conduit for about $87,000 annually – cut in 2009 when the recession deepened – that went to those families to help with in-home services.
Wednesday was the last day for companies to submit proposals to manage the state’s Medicaid program. Blue Cross Blue Shield of Kansas is not among the companies that sought the contract, saying it did not have enough time to properly evaluate the demands of the program.
The plan is the governor’s by executive privilege. The only role of the Legislature’s would be during the budgeting process.
“The proposal has me real concerned,” said Bill Otto, whose 9th House District includes Allen County.
“Tri-Valley provides its clients with jobs and gives them dignity,” Otto said.
Otto said he thinks managed care will result in less development of day-to-day living skills.
“It’s discouraging,” Otto continued. “The Legislature could pass a law” to override Brownback’s executive order, “but it would have to be veto-proof (a two-thirds majority in each legislative chamber), which isn’t be likely to happen with both houses being predominantly Republican.”
Managed care is more to do with health care than promoting independent living, which has Cunningham on edge. Tri-Valley’s goal is to encourage clients to live as independently as possible and deal with disabilities through structured environments and assistance, often one-on-one from a case manager.
Four states have had managed care for programs for the physically and emotionally disabled “and they have failed miserably,” Cunningham said. “In Wisconsin provider rates were cut by 15 percent; none have shown a savings. Florida has a pilot program (for managed care) in two counties and there’s little evidence of improved efficiencies.”
Most recently, Connecticut took back the responsibility to manage Medicaid services after having it with Hartford-based Aetna Insurance, one of the firms vying for Kansas’ business.
Connecticut officials said Aetna did not fulfill its promise of providing lower costs and better services.
Oklahoma also took back control of its Medicaid services in 2005, saying with the program under state direction it has been able to keep costs down when compared to having it managed by a private business.
Cunningham said the simple fact is that an insurance company willing to step in to manage care would take an administrative fee – he estimated 5 to 20 percent – which would reduce money available for client care.
That would exacerbate funding cuts of the past several years.
“We’re underfunded – a state study showed that – and we’re not serving the population (of those eligible for services),” Cunningham said. “Statewide there are 4,000” awaiting services mandated by the Kansas Development Disability Reform Act of 1995.
“Basically, managed care will duplicate what we’re already doing,” to manage Medicaid funding and services provided to clients, he said.
Services to the disabled are at about $42,000 per individual today – down from more $49,000 15 years ago and before budget cuts – and are funding-intensive because many clients require lifelong care 24 hours a day.
“Disabilities are birth to death,” Cunningham added.
IOLAN STEVE Uitts is a good example.
Uitts, 38, is vocal in his support of the services he gets from Tri-Valley.
He works in the Iola service center, 10 W. Jackson Ave., lives in a home near Cedarbrook Golf Course provided through Tri-Valley’s residential program and occasionally takes advantage of its transportation.
Uitts works six hours a day Monday through Friday, usually processing copper tubing that is cut into one-inch-long clips used in manufacturing of hose at Iola’s Gates Corporation plant.
Uitts worked in the Chanute service center until Iola’s opened two years ago. Employed there are 23 Tri-Valley clients, mainly from Iola but also from LaHarpe and Yates Center.
“I like coming to work every day,” Uitts said, saying he preferred to do the sanding of the copper clips, but “I’m pretty good at all of it.”
“We can put Steve anywhere we need him,” said Billie Reddick, service center supervisor. “He’s a good worker.”
CLIENTS AT THE service center also participate in art and horticulture therapy – they tend flowers in a pocket park next door – and learn to use computers.
Skills training is a part of the employment experience. They learn how to handle a job interview, how to dress for work and personal hygiene.
“We try to make them employable,” said Cunningham, which includes having job coaches who go along for a few days when a client secures a job.
Residential care is in group homes – such as the one Uitts lives in with two others – and apartments. They learn to live semi-independently, and a case worker is available when needed.
Transportation services are provided to about 140 clients a day. They are taken to service centers, doctor appointments, shopping and occasionally on outings. Tri-Valley has a fleet of 30 cars, vans and buses, and, Cunningham cautioned, the fleet is aging because budget cuts have strictly restricted new vehicle purchases.
Tri-Valley also has a nurse on staff – it had two before funding cuts – who helps clients with their medications, monitors their health and encourages them to be involved in wellness programs.
Individual case management is a major portion of services provided, with a care plan typically of 20 to 30 pages developed for each client and completely updated at least once a year.
“The case managers develop goals for clients to make them as independent as possible,” Cunningham said. “Also, as client advocates they deal with medical and safety issues and help with life skills plans.”
