An Introduction to KanCare Prepared for LeadingAge Kansas Members March 2012

What is KanCare? KanCare is the new Medicaid* Managed Care program for the State of Kansas. Implementation is set for January (There has been talk of a 6 month delay but this is unlikely.) (*Medicaid is the state health insurance plan for low income Kansans.) 2

Why KanCare? Medicaid is unsustainable as currently structured. – 7.4% annual increase in budget over the last 10 years. – Increasing enrollment due to economic downturn and projected aging of the population. According to the Administration, KanCare will: – Decrease the growth of the Medicaid budget by $850 million over the next 5 years. – Improve health outcomes for Kansans whose care is paid for by Medicaid. 3

How are goals to be achieved? Better care coordination and multidisciplinary case management, especially for people with complex health conditions and needs, should lead to: 1.Decreased emergency room visits and decreased avoidable hospitalizations. 2.Decreased nursing home use and nursing home length of stay. 4

Who’s involved: MCOs 1.Health plans/managed care organizations (MCOs) will assume responsibility for providing all Medicaid covered services to their respective members throughout the state. 2.3 KanCare MCOs will be selected by the State in June. 3.5 companies have submitted bids: 1.United Health Care, WellCare, Centene (aka Sunflower State Health Plan), Coventry (LTC subcontractor is Independent Living Systems), and Amerigroup. 5

Who’s involved: KanCare Members 1.All 380,000 Kansas Medicaid beneficiaries (called “Members”) Aged Disabled Children and families 2.Members will be auto-assigned late this year and have 90 days to change their MCO if they choose. 3.After that there will be an annual enrollment period. 6

Who’s involved: Health Care Providers Health care providers that accept Medicaid. 1.Includes Physicians, Hospitals, Nursing homes, Home and Community-Based Services, Behavioral Health, Substance Abuse, others who accept Medicaid. 2.Providers can choose to contract with 1-3 KanCare MCOs to provide services to MCOs’ respective members. 3.Providers that do not sign up to be in KanCare networks will be paid 90% of their typical reimbursement rate. 4.Nursing homes are guaranteed an offer from all MCOs for a 3 year contract. 7

Who’s involved: The State The State will: 1.Select 3 MCOs 2.Pay MCOs a capitated rate for which MCOs Maintain quality expectations and performance measures for the MCOs. 3.Institute monetary penalties for MCOs that fall short on specific quality and performance measures 4.Maintain control over basic rate setting for nursing homes 8

This presentation was prepared for us by LeadingAge Kansas, the statewide association providing advocacy, education, information, networking opportunities and dollar-stretching programs for not-for-profit aging service providers. Our organization is a LeadingAge Kansas member. Ph