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Federal Agency Urges KanCare Expansion Delay

Posted: December 18, 2013

All – this is a very significant development – NCD is urging CMS to deny Kansas’ plan to move IDD into managed care,  recommending a one year delay to address multiple issues. Below is a Kansas news article about this development, and further below is the full text of the NCD letter.

Federal agency urges KanCare expansion delay

National Council on Disability recommends more study before full inclusion of developmental disability services

Posted: December 13, 2013 – 6:13pm

By Andy Marso

The National Council on Disability sent a letter Friday to the federal Centers for Medicare and Medicaid Services urging CMS officials to further delay inclusion of long-term support services for Kansans with developmental disabilities into KanCare, Gov. Sam Brownback’s managed care plan for Medicaid.

KanCare began in January, with three private insurance companies awarded contracts to administer most of the state’s Medicaid services. State and local disability advocates successfully lobbied for a one-year “carve-out” of the long-term support services and have argued for an extension of the carve-out as their inclusion date nears. But Rocky Nichols, executive director of the Disability Rights Center of Kansas, said the letter sent Friday gives new fuel to that movement with the clock running out.

“NCD was created under federal law as the premier entity to advise the federal government on disability issues, so we cannot stress enough how important this recommendation is,” Nichols said.

Angela de Rocha, a spokeswoman for the Kansas Department for Aging and Disability Services, told the Kansas Health Institute her agency believes the national council got a “distorted” picture of the planned KanCare expansion during hearings it hosted last week in Topeka. She said administration officials weren’t given sufficient time to explain the transition.

Medicaid is a federal-state partnership and the Brownback Administration needs CMS approval to include the long-term support services for an estimated 8,800 Kansans with developmental disabilities into KanCare. That approval is still pending.

Brownback has said KanCare, by coordinating care, will save $1 billion over five years and improve health outcomes without cutting services, eligibility or provider payments.

Nichols and others have argued that the long-term support services those with developmental disabilities use to stay in their homes and communities rather than institutions are different than acute medical care and the managed care companies running KanCare have very little experience administering such services.

Andy Marso can be reached at Capital: (785) 233-7470; Office: (785) 295-5619 or
Follow Andy on Twitter @andymarso.


NCD Letter to CMS about Amendment to Kancare Medicaid Section 1115

December 13, 2013   

Marilyn B. Tavenner
U.S. Department of Health & Human Services
Centers for Medicare & Medicaid Services
Hubert H. Humphrey Building
200 Independence Avenue, SW, Room 445-G
Washington, DC 20201

RE:      Amendment to KanCare Medicaid Section 1115

Dear Administrator Tavenner:

The National Council on Disability (NCD) is writing in regard to Kansas’ request for approval of an amendment to the KanCare Section 1115 demonstration project.  NCD is an independent federal agency charged with advising the President, Congress, and other Federal agencies regarding laws, policies, practices, and procedures affecting people with disabilities.  As detailed below, NCD recommends that CMS not approve, at this time, the portion of Kansas’ 1115 Waiver Amendment that would transfer the Intellectual Disabilities/Developmental Disabilities (ID/DD) Waiver into managed care.  Instead, CMS should delay its consideration of Kansas’ proposed 1115 Waiver amendment for 12 months, pending the completion of an extended review by CMS of the concerns raised by both Kansas stakeholders and NCD.  Additionally, NCD recommends that CMS require specific changes to the structure of KanCare’s application to people with intellectual or developmental disabilities, such as an end to the institutional carve-out, and providing for a more robust and independent Ombudsman’s program.

As you may know, NCD recently held its Quarterly Meeting in Topeka, Kansas on December 4 and 5, 2013.  The meeting focused significantly on Medicaid managed care, including a panel discussion on the implementation of KanCare.  Topeka was the first of four cities NCD plans to visit to gather information about Medicaid managed care, particularly as it relates to people with disabilities.  During the meeting, NCD heard from KanCare consumers, advocates, and state officials on the implementation of Kancare.  The disability community shared their struggles with the implementation of KanCare, including some individuals facing substantial cuts to necessary care.  Conversely, Kansas state officials largely praised KanCare, however also admitted that there were some challenges.  Based on the testimony received, it is clear to NCD that many unresolved issues remain for people with disabilities.

NCD is deeply concerned about the pending consideration by CMS with regard to the proposed 1115 Waiver Amendment by Kansas to incorporate long-term services and supports (LTSS) for people with intellectual or developmental disabilities into the State’s managed care KanCare program.  Specifically, NCD has the following concerns:

NCD has dedicated significant time and resources to examining the impact of managed care on people with disabilities.  On March 18, 2013, NCD issued a report titled Managed Care for People with Disabilities: Policy and Implementation Considerations for State and Federal Policymakers, to assist with the implementation of managed care reforms without harming Americans with disabilities.[1]  In the report, NCD outlines twenty-two principles to guide the design and implementation of managed care services for people with disabilities.  NCD also recommends that CMS create and circulate a comprehensive, easy-to-understand procedure spelling out the process for determining state demonstration waiver requests that seek to link Medicaid managed long-term services and supports.

NCD recognizes that both state and federal government leaders may find distinct advantages, both fiscal and programmatic in utilizing a managed care approach to the delivery of health care services, as states and the federal government look for ways to improve care and manage Medicaid spending more effectively.  With strong oversight and equally strong planning, managed care can offer opportunities to improve the quality and cost effectiveness of care for Medicaid beneficiaries in the setting of their choice.  However, as NCD has repeatedly stated, transitioning people with disabilities into managed care involves many challenges and must be tailored to meet the unique challenges of people with disabilities.

Accordingly, NCD offers the following recommendations with regard to KanCare:

Thank you for your ongoing attention to this issue.  NCD stands ready to provide our support and research to Kansas and CMS to ensure that the implementation of KanCare, and managed care nationally, is not detrimental to people with disabilities and their families.  Please do not hesitate to contact Robyn Powell, NCD’s Attorney Advisor, at 202-236-9651 or if we can be of further assistance.


Jeff Rosen


Cindy Mann, JD
Director of the Center for Medicaid and State Operations
Center for Medicare & Medicaid Services (CMS)

Susan Mosier, MD
Medicaid Director
State of Kansas, Department of Health and Environment

Robert Moser, MD, Secretary
Kansas Department of Health and Environment

Shawn Sullivan, Secretary
Kansas Department for Aging and Disability Services


[1] National Council on Disability, “Managed Care for People with Disabilities: Policy and Implementation Considerations for State and Federal Policymakers,” March 2013, available at

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