KanCare Coverage Enhancements and Cost Efficiency
OVERVIEW
The KanCare system uses managed care organizations (MCOs), usually private insurance companies, to provide Medicaid services to those covered by KanCare. Under the contract between the private company and the state, KanCare pays the private company a certain amount for each person enrolled in coverage, regardless of whether or not that person uses services during that month.
Every five years, the state of Kansas goes through a reprocurement process with the private organizations that contract with KanCare. This gives the state an opportunity to change what is required by each private company and how much they pay per enrollee. New organizations can come into the KanCare system and companies can stop providing KanCare services at this time.
The Alliance for a Healthy Kansas advocates on behalf of recipients of KanCare services to ensure they get as many policy enhancements as possible and to work towards cost efficiencies in the contract process. Reprocurement is an important opportunity to advocate for improvement of the system for KanCare recipients.
2022 REPROCUREMENT DELAYED
During the 2022 Legislative session, the reprocurement process that was initially scheduled to begin in 2022 was pushed into 2023, until after the gubernatorial elections. This meant that the three KanCare MCOs were given a one-year, no bid contract extension. These three companies were Sunflower Health Plan, United Healthcare and Aetna Better Health of Kansas.
PRIORITIES FOR REPROCUREMENT IMPROVEMENTS
Each year an external quality review technical report is published for the KanCare system and the MCOs who provide services. The 2021-2022 technical report can be found here. This review is based on protocols developed by the Centers for Medicare & Medicaid Services (CMS) and evaluates things like information systems capabilities, providers surveys, and network adequacy validations, among other things.
Based on this report, during the reprocurement process, the Alliance for a Healthy Kansas will advocate for the following improvements:
- Prioritizing children and adolescent well-care visits;
- Screenings for cancers and sexually transmitted infections (STIs);
- Tobacco and alcohol use treatments and cessation;
- Improvements in MCO appeals and adverse benefit determination processes and procedures;
- Increased standards for culturally and linguistically appropriate services;
- Requiring MCOs to submit to the state information about health disparities and equity;
RESOURCES
The following are resources that you may find helpful on the topic of the KanCare MCO Reprocurement process.