When Jim Johnson hears state officials talking about reducing Medicaid spending by $853 million, with no reduction in services, he admits it makes him apprehensive. As executive director of Sunflower Diversified Services, Johnson fears what will happen to people with disabilities if Gov. Sam Brownback’s proposal is approved.
"Any thinking person would say ‘where does this $853 million come from,’" Johnson said. "The state’s plan indicates it will not cut services or the rates paid to agencies such as Sunflower. But logic says that cuts must occur to achieve the goal."
Medicaid is the primary funding source for adults with disabilities who rely on Sunflower. It helps pay for employment, residential and therapeutic services, as well as health-care costs.
Brownback’s goal is to reduce Medicaid spending by $853 million over five years by reducing current spending and slowing the growth of spending for all Medicaid services.
Of the total amount, $367.5 million would be state dollars and $485.5 million would be federal matching funds.
"These reductions not only would directly affect the people we currently serve, but also all of those on the waiting list," Johnson said. "They will continue to wait and more will be added to the list."
Savings are expected to come primarily from health-care coordination, with cheaper services, medications and other treatments.
"This concerns us on many levels," Johnson said. "For example, a less expensive medication might not work. People who have been stable on certain behavior-management or seizure medications could be required to switch to something cheaper.
"This could cause a relapse to the behaviors and medical issues that had been under control," he added. "If money is the issue, it will cost more to deal with the negative effects of making such rash changes."
Also, according to the state proposal, Sunflower individuals would be required to choose a managed care organization.
"We have many concerns about managed care," Johnson said. "Most people, including the people we serve, are not comfortable dealing with large insurance companies. Many can share negative experiences about dealing with HMOs or other similar programs."
In addition, Johnson said, the role of case management is uncertain. "The people Sunflower serves rely heavily on their case managers," he noted. "They may be allowed to continue these special relationships but we don’t know any details. If they had to sever these relationships, they would have to work with someone they don’t know and who doesn’t understand their needs."
Johnson said he understands that the state must watch the budget. But he doesn’t understand why the state wants to make all these changes by the first of next year.
"Such a pace does not provide nearly enough time to evaluate potential unintended consequences," Johnson cautioned.
Most states across the country have moved to such a system at a much slower pace, and only a handful have included developmental disability services in a managed care plan.
"And managed care has not been successful in any of those states," Johnson said. "Other states realized that developmental disability services shouldn’t be included in an impersonal managed care plan. I hope we learn from them."