By Dave Ranney
KHI News Service
TOPEKA, March 14
For weeks now, Rep. Bob Bethell, R-Alden, has been fielding questions about upcoming changes in how the state uses Medicaid to underwrite its foster care, mental health, substance abuse, and juvenile justice programs.
Answers, it seems, have been few and far between.
So on Wednesday, Bethell and the Social Services Budget Committee, which he chairs, hosted a two-hour roundtable discussion aimed at finding out how the new system, which kicks in July 1, is going to work.
Bethell soon learned that no one really knows
not yet, anyway.
Department of Social and Rehabilitation Services Secretary Don Jordan assured the gathering
a mix of about 30 advocates, program directors and state officials
that he was committed to ensuring as smooth a transition as possible.
But when program directors asked which of their services would be funded and how much they would be paid, Jordan said he didn”t know because federal officials have not yet approved the proposed changes.
Jordan said he expects a federal response in late April or early May.
That doesn”t leave much time for legislative oversight. This year”s session adjourns April 3 with legislators returning April 25 for the veto session.
“This really puts us in a nebulous setting,” Bethell said. “A lot of the decisions to be made in this area are going to be made after adjournment. I”m afraid we”re going to be leaving here with little or no understanding of what”s happening.”
Bethell said he”s likely to ask that an interim committee be appointed to keep tabs on the changes.
“Elected officials need to be involved in this,” he said.
The changes are driven by a series of federal audits that called for changes in how the state uses Medicaid to pay for mental-health and foster-care services.
“Everything in the (child welfare) system is being altered,” said Robin Clements, a lobbyist representing the state”s foster care contractors.
“Everyone wants this to be a smooth transition,” she said. “But here it is, March 15, and we have no idea what our costs are going to be or where the money is going to come from to cover those costs.”
After the July 1, foster children”s stays in group homes
now called psychiatric residential treatment facilities, or PRTFs
will be limited to 180 days. Medicaid will only pay for stays deemed “medically necessary.”
Ray Dalton, Deputy Secretary of Health Policy at SRS, said surveys have shown that about 25 percent of the children now in group homes will not meet the new funding criteria. SRS has 746 beds available through its group home contractors and they are usually full.
The uncertainty over how services for these children
and others like them in the future
will be funded irked Shelly Duncan, executive director at United Methodist Youthville, the state”s foster care contactor for Sedgwick County.
“I can tell you that on a daily basis we have anywhere from 10 to 20 kids who, basically, have no where to go at the end of day
these are kids who”ve had 30 to 40 placement disruptions within the past 6 to 12 months,” Duncan said, referring to children already displaced by the 180-day limit. “I”m very worried about how all this is going to impact these kids.”
Duncan reminded the committee that “at the end of the day, all of us here are responsible for these kids and their well-being.”
The federal audits also prompted SRS to hire a managed care company, Kansas Health Solutions, to oversee payments and admissions to the state”s community mental health centers.
“We didn”t even get to mental health today,” Bethell said, noting that mental health advocates have raised as many questions as the child advocates.
The changes” effects on mental health services will be the subject of a March 28 forum at the Topeka and Shawnee County Public Library, Room 202. Hosted by the Kansas Mental Health Coalition, the one-hour discussion begins at 11 a.m.
Jordan warned that SRS is likely to need an additional $20 million to offset the changes in Medicaid coverage.
Bethell found that hard to believe. “Twenty million?” he said. “I think it”s going to be way more.”
Bethell and Rep. Jerry Henry, D-Atchison, asked Jordan to set up a Web site for fielding and answering questions on how the new system will work.
The uncertainties, Henry said, conjured up unpleasant memories of the phone calls he received after lawmakers privatized the state”s foster care system in 1997. “I don”t want to go through that again,” he said.
But some predict bigger changes than that.
“This is huge,” said Bruce Linhos, executive director at the Children”s Coalition of Kansas. “This is bigger
much bigger
than what we did when we privatized foster care.”
-Dave Ranney is a staff writer for KHI News Service, which specializes in coverage of health issues facing Kansans. He can be reached at
dranney@khi.org
or at 785-233-5443, ext. 128.