Kan. budget plan ends 'carve out' for disabilities

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TOPEKA, Kan. (AP) — Kansas legislators are getting behind the Brownback administration's desires to shift services for the intellectually and developmentally disabled into the state's new managed care system, a move opposed by disability advocates.

The plan calls for ending a special exemption, or carve-out as it is called, for developmental disability services and putting those clients in the state's KanCare health system, which is managed by three private health insurance companies. But disability advocates are wary of that very thing.

"Historically, the insurance industry has never been a friendly environment for people with disabilities," said Tom Laing, executive director for Interhab, which represents providers of services to the developmentally disabled.

More than 1,000 people packed the south plaza on the Capitol grounds on May 8 to urge Gov. Sam Brownback to keep services for those individuals separate from the state's KanCare program.

Brownback and his allies believe that the state's Medicaid overhaul that took effect in January will cut the state's costs and provide better-coordinated and more effective care.

State officials have pointed to recent projections of saving $62 million more than previously anticipated during the current fiscal year and the fiscal year beginning July 1 as proof that KanCare is working well. Brownback proposed earmarking $8 million in savings to in-home services for the physically and developmentally disabled, reducing waiting lists for those services.

Advocates have pushed the state for years to increase spending on in-home services, which can include an attendant to help the disabled with daily tasks, so that they can live as independently as possible. More than 5,500 Kansans were on waiting lists for such services in April.

"This is an attempt to just run over the community voices that have been calling for the carve-out," Laing said. "It's not over yet, but it puts our backs clearly to the wall."

Senate Ways and Means Chairman Ty Masterson said his concern with the proposal was what it meant for those receiving services and whether they'd be able to keep their care managers and service providers. The language in the budget would keep those elements in place for the disabled.

"We're hoping it offers reassurances and to some degree legal recourse for residents," said Masterson, an Andover Republican.

He said by putting into law all the promises made by the Brownback's administration regarding the level of care and continuity of providers would hold the three managed care organizations accountable.

Rep. Arlen Siegfreid, an Olathe Republican, said studies have indicated that bringing the developmentally disabled under a managed care system produces the best outcomes. The proposed change would "hold the administration's feet to the fire" to produce those results and the desired cost savings to the state.

"I think the best public policy should be based on what's best for those people with disabilities," Siegfried said.

But House Minority Leader Paul Davis notes that advocates for the disabled have fought for years to get services and resources for their clients. He doesn't think managed care organizations are best suited to meet client needs as the current community-based providers are.

"I don't think that putting the developmentally disabled population within the KanCare program is the right thing to do," said Davis, a Lawrence Democrat. "This is the paramount issue for the developmentally disabled community."

Legislators are expected to debate the budget proposal next week. Masterson and others, however, say prospects of passing the bill, which spends some $14.5 billion in each of the next two fiscal years, is uncertain.

"Nobody knows what will pass the House," he said.

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