Some Kansas case managers who provide treatment for Medicaid enrollees suffering from mental illness were reportedly shocked to learn that months of health care services they provided were not eligible for reimbursement because their patients had been moved to “health homes” without their knowledge. The Kansas Health Institute (KHI) News Service reports that Kansas state officials have announced a change to the health homes transfer notification policy, but questions remains as to the benefits of the program.
In August 2014, Kansas launched the Health Homes Initiative for an estimated 36,000 Medicaid enrollees suffering from ongoing mental illnesses. The aim of the Kansas health homes program was to provide better coordination of physical and behavioral health treatments for people with mental illnesses by bringing together their health care providers under three managed care organizations that administer KanCare, which is the state’s Medicaid agency.
Kansas opted to employ a team approach to implementing health homes program, which utilizes a team of health professionals that may include a physician, nurse care coordinator, social worker, or behavioral health professional and can be based in a hospital or a free-standing health center or can even be virtual.
While the implementation of the health homes initiative was initially scheduled for January 1, 2014, the program faced delays and has not been without its critics since it began a year ago. It is estimated that over 80 health care providers across Kansas offer health home services to mental health patients.
Section 2703 of the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) promotes the use of health homes for certain high-cost patients by increasing federal Medicaid matching from 60 percent to 90 percent for two years. Some have noted that the state’s embrace of a component of the ACA may be surprising in view of some of the state politicians’ criticism of the health care law.
Case managers appeared before the Joint Committee on Home and Community Based Services and KanCare Oversight (Joint Committee) to express their frustration over the lack of notification when clients are transferred into health homes. Mike Randol, Director of Health Care Finance for the Kansas Department of Health and Environment, (KDHE) reportedly informed Robert Bethell of the Joint Committee that KDHE would be changing its methods of notification by sending case managers letters when their clients have been placed in health homes. He reportedly stated, “That’s the process we’re working on now, so that we can hopefully alleviate some of these issues and concerns.”
In addition to notification issues, some case managers have questioned whether the program actually benefits their clients. Roxanne Hidaka, co-owner of Case Management Services, Inc. in Overland Park, Kansas reportedly told the Joint Committee that she does not believe that the program is effective. She said, “All the fanfare about the benefits of people being in a mental health home are not being seen or delivered.”
During the Joint Committee hearing, some case managers such as Marylin Kubler, Director of Jenian, a case management company, suggested providing notification to the parents of clients who were being placed in health homes. Hidaka agreed with this suggestion noting that some clients do not understand the notification letters that they receive and often do not know about the benefits or disadvantages of health homes and whether they should opt. However, Randol indicated that there may be limitations to the notification that can be provided due to privacy laws.
State officials were seeking to expand the health homes program in 2015 to include other Medicaid patient groups including those with chronic conditions such as diabetes and asthma, but Kansas Republicans placed a proviso in the budget that delayed any expansion for a period of two years.