The amount of money being reimbursed to the state for Medicaid  from the federal government has been cut, and the state continues to see budget shortfalls.
A group lead by Lt. Gov. Jeff Coyler is trying to form ideas on how to cut state Medicaid costs without seriously cutting services to Medicaid patients.
But local officials have expressed concern about how the changes to services to disabled, the most costly group in the Medicaid system, will affect care.
Kansans who receive Medicaid fall into three basic low income categories: disabled, children, families and pregnant women, and elderly.
Children and families account for about 57 percent of the enrollment in Medicaid but only 21 percent of the costs. Medicaid spends about $240 per month per member on this population.
The aged population accounts for less than 10 percent of the Medicaid population and about 20 percent of Medicaid expenses.
The average cost for those elderly in in-home care is $1,299 per month, and the cost for elderly in institutions is about $2,427 per month.
The greatest percentage of spending goes to people who are disabled.
This includes people with physical and development disabilities, mental illness, and traumatic brain injuries.
Costs can range from $871 per month to $6,889 per month.
About 49 percent of growth in cost in the Medicaid program from 2005 to 2010 in Kansas came from care for persons with disabilities.
One area that the reform group has discussed is eliminating mental-health services for people who have developmental disabilities.
The idea would be for people who have developmental disabilities to receive psychiatric care from their primary-care physicians.
Prairie View Medical Director Dr. Gary Fast, MD, said some psychiatric disorders when stable and uncomplicated can be managed by primary-care physicians.
However, denying psychiatric care for patients with development disabilities could hurt quality of care, he said.
“Primary-care physicians are not trained in the intricacies of psychiatry medication management, so there would be some with psychiatric disorders that should be managed in the psychiatric clinic,” Fast said in an e-mail. “Even the national push for mental health integration into primary care says there are some patients who need to be managed by a psychiatrist.”
Fast said the challenges in knowing which patients can be managed by a primary-care physician and which need a psychiatrist. He said better communication between specialist and primary-care physicians need to occur.
“Adding the dual diagnosis component makes for the more complicated patient at times,” Fast said. “The quality of care could certainly go down if the average length of a (primary-care physician) visit is six to eight minutes and the (primary-care physician) does not have time to ask the questions that need to be addressed with the dual diagnosed patient.”
The group has further proposed requiring all Medicaid patients with mental illness to take generic medication.
Jessie Kaye, Prairie View CEO, said providers in the public mental-health system oppose policies that restrict access to medically necessary medications.
Prairie View is Harvey County’s Community Mental Health Center.
“Providers in the public mental-health system oppose policies that restrict access to medically necessary medications. Such policies, which include preferred drug lists (PDLs) with prior authorization requirements, restrictive formularies, fail first requirements, monthly prescription limits, and tiered co-payment structures, fail to achieve their intended purposes of reducing overall health-care costs, prolong human suffering and reduce the potential for an individual with mental illness to achieve full recovery,” Kaye said in an e-mail.
“Moreover, restrictive policies fail to acknowledge that physicians and consumers should make treatment decisions, to recognize the unique and non-interchangeable nature of psychotropic medications and to acknowledge that lack of access to medications has both human and fiscal consequences,” she said. “We support quality, cost management practices, and use of best practices to ensure safety and avoid poly-pharmacy.”
Fast said he thinks starting patients on generic medication is acceptable, when it is available, but an overreaching policy could lead to problems.
“The problem is when we have a stable patient on a brand name medication who is forced to switch to a generic. This usually causes a destabilization of a patient and has led to hospitalization,” he said. “Not all brand name medications have a generic, therefore, if we are unable to use certain medications that we feel are best for the patient, then, yes, I believe that we will offer a lesser quality of care.”
Marc Rhoades, R-Newton, and chairman of the House Appropriations Committee, attended a Medicaid reform focus group that was conducted earlier this month in Wichita.
“The administration’s emphasis isn’t on cutting services, but
uncovering practical, common sense ways to better utilize limited Medicaid dollars, “ he said.  “That’s what the statewide focus groups are about — gathering information from communities regarding better efficiencies.
“This is where the best information will be found, not
from top-down bureaucratic systems, but from people on the ground informing the system. The federal government has reduced Medicaid dollars to the states, which means individual states must make adjustments as well.”
Beth Tuszynski, director of the Harvey County Community Partnership, also attended the recent focus group in Wichita. As the officials at Prairie View did, she expressed concerns about the proposed reforms.
“I believe the governor and lieutenant governor want to help Kansans. I think they do not want to cut services, but I think the areas where they purpose to cut costs do cut services people need most,” she said. “I think we need to better manage care, reign in fraud and not paint with such a broad brush, so we can give health care or mental-health care in the best way possible.”