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Kansas Medicare expansion compromise reached
Kansas Medicare expansion compromise reached
laura kelly mug
Laura Kelly

TOPEKA – The announcement Thursday morning by Kansas Democratic Governor Laura Kelly and Republican Senate Majority Leader Jim Denning of a compromise proposal to expand Medicaid met with approval from the state’s health-care community.

“Access to quality health care is a foundation of stable, thriving lives and communities,” said Bob Page, University of Kansas Health System president and chief executive officer. “We see every day the positive impacts of accessing quality care close to home in our hospitals and clinics from Great Bend to Hays, and Topeka to Kansas City.”

Page said the hard work and commitment by Governor Kelly, Senator Denning and the Legislature to find a workable solution for everyone involved is appreciated. “Now, more Kansans can see a clearer path to meeting their health-care needs. With expanded Medicaid coverage and less uncompensated care, hospitals and clinics throughout the state will be able to focus critical resources on evolving patient needs.”

As communities change, they must continue to re-imagine how quality health care can be delivered most effectively across our state, he said.

 “Expanded health-care coverage is one part of a broader solution. We look forward to continuing to work with partners across the state of Kansas to chart a new path forward for healthier, sustainable communities.”

In addition to expanding eligibility, the plan includes a requirement that Kansas pursue a Section 1332 reinsurance waiver, said Tom Bell, president of the Kansas Hospital Association. Advocates are pleased that the plan does not include a work requirement nor a lockout. An essential component of this agreement insisted on by both Gov. Kelly and Sen. Denning is a “hospital surcharge” that will be used to help offset the state’s share of expansion costs.

“This agreement is clearly the most significant progress we have seen in the Medicaid expansion debate in Kansas,” Bell said. “The fact that Gov. Kelly and Sen. Denning have agreed in principle on a plan is momentous. It represents real compromise and is undoubtedly the best, and maybe the only, way to get this through the Legislature.

“KHA members are enthusiastic about the opportunity to expand health-care coverage to thousands of hardworking, low-income Kansas,” Bell said, adding it is an example of how Republicans and Democrats work together in a bipartisan manner. “KanCare expansion is a benefit to individual Kansans, Kansas health-care providers, Kansas businesses and Kansas communities.”

More to be done

The deal to expand Medicaid while lowering health insurance premiums for Kansas families took weeks of negotiations, Kelly said.

 “This process is far from over, as there are still several critical steps to be taken by the Kansas Legislature,” Kelly said. “But today, Senator Denning and I are proud to stand together to propose a bipartisan compromise that will expand Medicaid and lower health-care costs for Kansas families. This proposal includes elements of my plan, of Senator Denning’s plan, of the 2019 House plan, and of the bipartisan plan that passed both chambers in 2017.” 

“My top priority is to lower the cost of health care for Kansans across the board. We want to give as many Kansans health-care coverage as we can, in the Medicaid market and the non-Medicaid market,” Denning said.

While this proposal is the most sweeping compromise offered since the debate over Medicaid expansion began in 2013, both Kelly and Denning underscored that more work remains. 

“We’ll both be working with our respective caucuses in the coming days to get their feedback and buy-in,” Denning said. “But all sides can find something in this bill to like. That means it’s probably about as middle of the road as it can get.”

“This compromise was an important first step, but our work is not over yet,” Kelly said. “Legislators, many of whom were here today, have the ability to bring this over the finish line in the early days of the 2020 session. I am calling on them to do just that.”


What’s in the compromise proposal to expand Medicaid in Kansas?

The compromise proposal includes key elements to address concerns raised from both parties, in both chambers:

• Full Medicaid Expansion: The proposal includes a full expansion of Medicaid to 138% of the Federal Poverty Level (FPL) with a 90/10 match, to be effective no later than Jan. 1, 2021.

• Reinsurance: Pending Centers for Medicare and Medicaid Services (CMS) approval of a 1332 waiver and release of funding by the State Finance Council, the proposal includes a reinsurance program to be effective no later than Jan. 1, 2022. The agreement also requires the Kansas Insurance Department to complete an actuarial study of the reinsurance proposal and submit to the State Finance Council.

• Medicaid Funding: The proposal includes an annual hospital Medicaid expansion support surcharge of up to $35 million, which has been endorsed by the Kansas Hospital Association, to be effective July 1, 2021. This compromise proposal does not require a tax increase.

• Promoting Personal Responsibility: The agreement includes a robust work referral program that promotes self-reliance for non-working Medicaid beneficiaries, while limiting costly administrative red tape that drives up overall costs to taxpayers. Enrollees within the expansion population will make a modest contribution for health services through monthly premiums of up to $25 per month, or $100 for a family of four, as proposed in House Bill 2066.  The bill does not contain any lockouts. Instead, it collects unpaid premiums through the state’s debt setoff program. A hardship provision is also included.

• Rural Health Care Innovations: The proposal creates an advisory committee within the Kansas Department of Health and Environment to support rural hospitals in assessing viability and identifying new delivery models, strategic partnerships and implementing financial and delivery system reform to improve the health of rural communities.