New York isn’t Kansas … or is it?

Pending final approvals, KanCare goes live for people with developmental disabilities on January 1, 2014. For the first time managed care by large for-profit, national insurers will take full responsibility for all Kansas Medicaid recipients. That includes all services for people with developmental disabilities, both acute care and long term care.

These firms have almost no experience caring for people with developmental disabilities. That’s not why they were formed. They were formed to make a profit and profit can come at the expense of care. Just yesterday Centene — one of the three for-profits in Kansas — announced that for the third consecutive quarter it beat estimates and achieved a whopping 23 percent increase in revenue from its Medicaid managed care business. Understandably, Kansas families are anxious which was clear at a hearing last week attended by the National Council on Disability in Topeka.

“This is an unprecedented model. No state has ever taken a developmental disability population and placed it in an arrangement like this, with an out-of-state managed care system, all at once,” said Rocky Nichols, executive director of the Disability Rights Center of Kansas, a legal advocacy group. “It’s almost like throwing everyone into the deep end of the pool.”

New York’s Medicaid program is so vastly larger than the Kansas program that it’s hard to draw conclusions about what will happen here based on what’s happening there. That size difference allows New York to try something that wasn’t possible in Kansas. In New York, mission-driven, nonprofit developmental disabilities providers hope to convert themselves into insurance companies and become their own managed care organizations.

It’s become a painstaking, expensive and prolonged process which ultimately depends on a series of highly sensitive and deeply politicized federal approvals and, perhaps, the patience of state officials. So while back in Kansas for-profit insurers tell shareholders about big profits from the Medicaid managed care boom, in New York people with developmental disabilities and their families anxiously await official decisions that depend on resolving a tangle of complex issues with potentially profound human consequences.

As this drags out, it would be naïve to believe that giant for-profit insurers are not busy behind the scenes in Albany telling impatient state officials how much easier their lives would be if they just handed the keys to the state’s huge developmental disabilities system over to them with their vast store of investment ready cash and established infrastructure. It could be just like Kansas, the only difference being that the revenues and profits would be so much larger. Large nonprofit insurers are similarly positioned to take over though, lacking a profit motive, they seem less aggressive.

For now, Albany decision makers seem to understand the importance of a managed care system run by traditional developmental disabilities nonprofits. Further, after the past few years of bad national publicity, New York Times stories and CMS oversight, there’s hope that state decision makers would be reluctant to risk sacrificing the quality of our programs with a large insurer lacking developmental disabilities experience, especially a for-profit insurer.

Still, nothing is guaranteed, the future could be a long way off and it would be a mistake not to keep our eyes wide open to all the possibilities. The only certainty is that our families and those in Kansas share common aspirations for their loved ones. Our thoughts and hopes go out to them.
Marc N. Brandt, Executive Director

NYSARC, Inc.