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Medicaid transition leads to staff cuts




The transition to managed care for Kansas Medicaid patients has caused significant changes for home- and community-based service programs such as SKIL and LINK in Hays.

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The transition to managed care for Kansas Medicaid patients has caused significant changes for home- and community-based service programs such as SKIL and LINK in Hays.

When the new Medicaid program, KanCare, was implemented Jan. 1, the case management services previously offered by local agencies were handed to the three for-profit managed care companies now administering the program. Both SKIL and LINK, which have other offices in the state, lost approximately half of their staffs.

"A lot of those case managers were hired by the managed care companies, which was good. At least they've got jobs," said Lou Ann Kibbee, independent living program manager at SKIL. "And it makes sense for the managed care companies because a lot of them had been doing this for so many years. They're very qualified."

Statewide, SKIL had 40 staff members, nine based in Hays. LINK previously had a staff of 22, and that number has been reduced to 13. Both agencies provide home-based support to residents with physical disabilities and traumatic brain injuries.

The subsequent reduction in funding after case management services were outsourced also led SKIL to move into a smaller Hays headquarters. The remaining five local staff members moved to a new office at 510 W. 29th, Ste. A, on May 15.

The move and staff reduction prompted rumors the Hays branch of SKIL was closing, Kibbee said.

"We want the community to know with all the changes happening, we're definitely still here," she said. "We're moving forward."

Both organizations are looking for ways to work with the managed care companies and expand their services. LINK is increasing services in the southwest part of the state, and SKIL has contracted with the MCOs to provide services such as personal assistant payroll.

The local case managers performed functional assessments and helped consumers secure needed services.

Some consumers have been able to keep their same case manager if that individual now is employed by their Medicaid provider, Kibbee said.

The transition has caused concerns for service administrators and individuals receiving at-home support. Some consumers developed a trusting relationship with their case managers, which made it difficult for them to open doors to someone new, Kibbee said.

"It can be difficult to open your home to people, so they still contact us with a lot of their questions, and some of them want our staff to be there when the case manager comes in, just so they'll feel comfortable," she said.

The MCO case managers responding to local consumers have been assigned a larger case load, and there has been concern that might make it more difficult for everyone to quickly access the services they need, said Brian Atwell, executive director of LINK.

"They're also providing a lot more (services) per case manager," Atwell said. "That's the big thing we were worried about -- consumers having choice and control and still getting care."

Rilee Scheibler, a Hays woman who receives services through SKIL, said it can be frustrating trying to obtain information from the MCOs in a timely manner.

"I just don't think there's enough people," she said of the MCOs' Kansas staff. "It's very frustrating."

Despite some bumps in the road, however, Atwell said he is confident MCO employees are doing the best they can.

"I don't want to come across as negative toward the MCOs. They're doing good work; they're doing as good as they can," he said. "They're having to please the state and all their contract regulations, and at the same time they're working with providers."

At SKIL, Kibbee said many consumers' biggest concern simply has been the uncertainty of moving in a new direction.

"Managed care is always pretty scary, I think, to most people, and I think a lot of it is not knowing what to expect," she said. "We've worked hard to try to build those relationships with the managed care companies. Is everything going the way we'd like it to and as smooth as we'd like it to be? Probably not.

"It's still very confusing to our customers. But we work hard to try to educate them about it."