KanCare: Reinventing Medicaid for Kansas

Consumers

Frequently Asked Questions

Care Coordination

1.  Are health care coordinator services available to everyone under KanCare?       
Generally, yes, although more intensive care coordination will happen with people who have chronic conditions, like diabetes, or complex needs like multiple conditions.

2.  Are you just making it seem like the care coordinator is to make patients life better, but in reality is to allow the state to manage the cost of all the doctors to save state $ not for the best interest of the patient?
Care coordination is really about coordinating care, so the patient and all providers are aware of all the care a patient receives. It is also about helping the patient learn to manage his or her own chronic conditions.  Care coordinators will be responsible for helping patients stay healthy.

3.  How many clients do care coordinators have?  
The answer will vary by MCO and by the needs of the people assigned to each care coordinator.  Care coordinators with more complex patients will have fewer people.

4.  How will a KanCare card holder contact their care coordinator or service coordinator?  
You will receive a welcome packet from your health plans with information about how to contact your care coordinator.  They may also contact you soon after you are enrolled in the plan.

5.  How will I know who my care manager is?     
The MCO will provide you with that information as well as information about how to contact the care coordinator.

6.  Is a care manager the same as a care coordinator?        
Yes, sometimes these two terms are used to mean the same things - someone who will help you get coordinated health care and manage any chronic conditions you have.

7.  Is care coordinator the same as care manager?
Yes, sometimes these two terms are used to mean the same things - someone who will help you get coordinated health care and manage any chronic conditions you have.

8.  Is the care coordinator an employee of the state or the MCO?  And what will the person’s credentials be? Yes.  They are usually a nurse , but sometimes they're a social worker.

9.  Is the coordinator going to be like case managers?        
Care coordinators will make sure the consumers get the services they need.  They will help the member get signed up for special programs, like quitting smoking.  They will also help with moves from the hospital to home.

10.  Is the interaction with care coordinator face-to-face?   
Sometimes interaction will take place over the telephone and sometimes in person, depending upon the needs of the person.

11.  What is the ratio of Medicaid members to care managers?        
The answer will vary by MCO and by the complexity of the people assigned to each.  Care coordinators with more complex patients will have fewer.

12.  Where are the care coordinators housed?  Are they from providers, the state or KS department?
Care coordinators are employed by the MCOs.  They will be located across the state.

13.  Where are the care managers located?           
Care coordinators are employed by the MCOs.  They will be located across the state.

14.  Where do you get the service coordinator?   
The MCO will assign a care coordinator to you.

15.  Who are the care managers?                             
This is someone employed by the MCO to help you get and keep appointments and coordinate your health care.

16.  Who is the care coordinator?                             
This is someone employed by the MCO to help you get and keep appointments and coordinate your health care.

17.  Who is the care manager and who assigns them to me?              
This is someone employed by the MCO to help you get and keep appointments and coordinate your health care. The MCO will assign your care coordinator.

18.  Will DD care managers have access to the system for those with volunteer guardians who leave everything to case managers to handle?        
If you are referring to helping someone choose their MCO, guardians and current case managers can certainly help someone choose their MCO.

19.  Will my care coordinator work with my case manager I have now?
Care coordinators will work with all of your providers to make sure care is effectively coordinated.  In some cases your care coordinator will be your case manager, who will work for the MCO.

20.  Will the care coordinator be a medical doctor or a social worker?           
Care coordinators will be nurses or social workers.

21.  Will those with mental illness or intellectual or developmental disabilities be in contact with the service coordinator or care coordinator?       
Yes, if they have chronic conditions or complex needs.

22.  How many patients will the care coordinator have on her case load? Will she/he have time to see everyone? Caseloads will depend on the complexity of the members needs. Some members will not need to see their care coordinator, but will talk with them by phone, others will have in-person visits.

23.  Is a service coordinator a care coordinator, or a care manager?
The terms care coordinator, care manager, and service coordinator are sometimes used interchangeably. They mean the person at the MCO or KanCare health plan who coordinates the care for a member with special or complex needs.

24.  Who does that person work for?                      
This person may be asking about the care manager/coordinator.  They will work for the MCO.

25.  How many people are on a care coordinator’s case load?
This will depend on a few different things, such as how complex the care needs of each consumer are, how far the care coordinator has to drive, and it will vary by plan.

Case Management

1.  Where are the care managers located, and what is their background?   
Care managers are employed by the MCOs.  They will be located throughout the state.

2.  Who does that person work for?                      
This person may be asking about the care manager/coordinator.  They will work for the MCO.

3.  If I am on HCBS services and all the case managers are leaving to work with MCOs who will cover my care for the rest of the year?
Every agency providing targeted case management is responsible for ensuring that the service continues to be made available until it is taken over by the KanCare MCOs. The state has provided transition guidance to all current providers regarding the successful completion of this work until KanCare is initiated.

4.  If we have targeted case management, can we keep the same targeted case management under the DD waiver?
Yes. All consumers on the DD waiver will keep their current case managers.

5.  What will happen to the current case managers?
Case management services, as an important part of the overall care management expected under the KanCare program, is being addressed differently based upon which service system is involved. For some, targeted case management is continuing as is; for others, it is being folded into the MCOs as part of their care management program. Many of the current case managers will continue in their role; many are being hired by the MCOs to serve in care management positions.

Case Reviews

1.  Are your yearly reviews done by doctors?     
KanCare consumers may have two yearly reviews.  Each person has a yearly eligibility review done by the State.  This review is done at either the Clearinghouse or a local DCF office.  Some consumers also have reviews for their long term services and supports.  Those will be done by MCO care coordinators or by other staff that work for the MCO. 

2.  At the time of review, who makes the decision concerning a need to change the services you are getting?
KanCare consumers may have two yearly reviews.  Each person has a yearly eligibility review done by the State.  This review is done at either the Clearinghouse or a local DCF office.  Some consumers also have reviews for their long term services and supports.  Those will be done by MCO care coordinators or by other staff that work for the MCO. 

3.  Board does case reviews?  Or case managers?  
KanCare consumers may have two yearly reviews.  Each person has a yearly eligibility review done by the State.  This review is done at either the Clearinghouse or a local DCF office.  Some consumers also have reviews for their long term services and supports.  Those will be done by MCO care coordinators or by other staff that work for the MCO. 

4.  Who does case reviews?  Board or case managers?        
KanCare members may have two different types of yearly reviews.  Every person in Medicaid has a yearly eligibility review done by the State (either at the KanCare clearinghouse in Topeka or at local DCF (formerly SRS) offices.  Some members may have yearly reviews for their long term services and supports.  Those will be done by MCO care coordinators for some people or by providers contracting with the MCOs.

Choosing a Health Plan

1.  How often can a person change insurance companies if they are unhappy?       
Consumer can change once a year at their open enrollment. They can change during the year if they have a good cause reason. Good cause reasons would involve quality of care issues, access to care issues or a treatment not available in network.

2.  If approved by January 2, 2012, do consumers have 45 or 90 days to change MCO?       
The State has agreed with CMS to allow consumers 90 days, beginning January 1, to change their MCO.

3.  How do the MCOs differ and how will I choose the right one?   
The health plans (or MCOs) will all have to offer the services you are getting today.  They all are going to try to sign up all current providers.  However, some of your providers may not sign up with all three plans.  You should choose a plan based on where all of your providers are enrolled.  Each plan will also offer extra services (called value added services) that will be different.  You should look at the list of extra services and see if any would benefit you.  If you need help choosing a plan you can call Medicaid and someone can help you, or go to a local outreach center for help.

4.  So if my 3 children have different needs they can have different MCOs?             
Yes, you will have a choice to have 3 different plans for your 3 children if you so choose.  At the first auto enrollment in November your children will most likely be assigned to the same plan.  You can call in and change each child's plan in November, December and January. 

5.  What is the reason for three complicated provider plans?          
The federal government requires that people be given a choice of at least two managed care plans.  We wanted to provide that choice and more so that members can select a plan that best meets their unique needs.  The State believes that managed care plans can help increase the number of providers who join Medicaid and can offer some services that the State is not currently able to, such as a preventive adult dental benefit.

6.  Will the disabled need to select a health plan in November?      
Yes.  With very few exceptions, all Medicaid consumers will need to choose a health plan.  This includes consumers with disabilities. 

7.  Will there be access to all MCO details so that educated choices can be made?
Yes. You will receive an enrollment packet this fall with information.  It will include a chart that compares each MCO.  The packet will also tell you how to check if your current providers are enrolled in each plan.  The MCO will also have additional information about their plan in the packet and website where you can go for more information.

8.  Will the packet we receive in November have a provider list for each of the 3 MCOs?     
The packet will not have a list of the providers, but will have information about how to find out if your provider is in each plan.  You will be able to call the MCOs to ask if your provider is enrolled with them.  You can also check the website for each company.

9.  What if my doctor is not on the provider list?   
You should check with all of the MCOs to find out if your doctor signed up with any of them.  If your doctor hasn't signed up, you can call them and encourage them to sign up so you may remain their patient.  You may be asked to choose a provider that is signed up with your health plan if your doctor does not want to participate and another doctor can provide the care you need.

10.  You indicated that beneficiaries will have 90 days not 45 days as indicated in the 1115 waiver to select an MCO, will this 90 days split into 2 timeframes of 45 days?        
It has been decided that all individuals will have 90 days from the start of coverage to make a change to their health plan.

11.  What if your primary doctor is not in the plan you want?           
After the initial assignment of an MCO the consumer will be able to change if they wish to do so. You will have 90 days after that first assignment to complete this. The consumer will need to evaluate their needs and the provider network to determine which MCO fits their needs.

12.  If your needs change what happens then? If you need to change your plan is that possible after the date?
If your needs change and your health plan can no longer provide you the care you need in their network, that would be what is called a "good cause" reason to change. You would be able to choose a new plan if your current plan cannot meet your needs.

13.  Do we have to wait until November to investigate the plans offered by each of the 3 service providers?
No. You can go onto each of the plans' websites now and start reviewing them.

14.  What kinds of differences are there in the 3 health care plans?
Each of the three plans will offer different value-added services. They each may have slightly different provider networks, so you will need to make sure your doctor(s) are in the plan you want.

15.  If you were put on Plan A and switched to Plan B before 12/31/12, could you switch again (if needed) to Plan C, after 1/1/13 but before 2/15/13?
Members can change plans as many times as they like during the choice period. After the initial choice period ends, members will be locked into their plan for one year, unless they have a good cause reason to change. Good cause reasons include things like the plan not be able to offer a covered service in network.

Co-Pays

1.  I pay $100 a month for Medicaid, will that change?       
There are currently no co-pays in Medicaid and there will not be any going forward with KanCare.  CHIP and Working Healthy  premiums will still need to be paid.  Spend-down will still need to be met.

2.  With Medicaid, is there still no copay?            
Consumers in KanCare will not pay a co-pay. 

3.  Will I still pay $3.00 for each of my prescription meds or will it be higher?              
Neither. There will be no pharmacy copays in KanCare.

4.  Will KanCare pay for copays as a secondary insurance even if current doctors on primary insurance aren’t part of the assigned MCO?            
No.

Coverage

1.  Are hearing aids covered? I have Blue Cross/Medicare, do I need this Medicaid?             
Yes. The member must decide if Medicaid coverage is beneficial to them.  Medicare and Blue Cross will pay their portions first and it is possible that Medicaid will pay a portion of the remaining costs.

2.  Are the plans going to cover wellness care versus hourly sick care?        
The plans will cover wellness and preventative office visits.  Sick care will be provided through an office visit or other service location as needed.

3.  As a foster care giver for children, will KanCare provide braces as of now the Medicaid card does not?
Orthodontic services require approval before the service is completed and are only covered for certain children. Children with severe orthodontic problems caused by genetic deformity such as cleft lip of cleft palate are eligible for this service.

4.  Can one of the providers deny me coverage on an incident or procedure, but my friend having exact procedure and has a different provider who agrees to the procedure?      
Yes. Decisions will be made on an individual basis, based on medical necessity.

5.  Does dental cover braces?                                  
Orthodontic services require approval before the service is completed and are only covered for certain children. Children with severe orthodontic problems caused by genetic deformity such as cleft lip of cleft palate are eligible for this service.

6.  Family member has seizures/blackouts. His epilepsy doctor wanst him to have video monitoring, hospital stay 3 to 7 days, will this procedure be covered?           
Medicaid covers treatment of seizure disorders. Treatment will require medical necessity documentation.

7.  I have degenerative disc disease with a pain pump.  Several doctors coordinate care in specialty hospital.  Will these services change?              
You will still be able to get the same services, but may have a different provider if your current provider chooses not to participate in KanCare.

8.  I have to have special water filters, humidifiers, and air changers, plus a lot of over the counter medication.  Will they be covered under KanCare?        
Items that are not medically necessary and over the counter medications may be included as a value added service.  Each MCO can cover different things as value-added services, so check with each plan to see which best fits your needs.

9.  If a person on KanCare has sleep apnea, will KanCare cover needed equipment for treatment, such as a C-PAP?                  
Currently CPAP is covered for members under age 21. The MCOs may include this as a value added service for members above age 21.

10.  If you are disabled and you need some home care, is there a change for that?  
No. KanCare guarantees you will receive at least the same services you are getting today. Coverage will continue to be based on your individual needs and medical necessity. Individuals who are eligible and in need of home care or home and community based services may receive those services as they do today.

11.  Is dialysis covered? Is vision covered?             
Dialysis and Vision services are covered as they are today.  The MCOs may offer additional vision services as a value added service.

12.  Is sleep anpea treatment included in KanCare, for example, CPAP and supplies?             
Currently CPAP is covered for members under age 21. There is no plan to change the coverage for this service, unless an MCO decides to provide additional value added services in this area.

13.  Kan-Be Healthy still available?
Yes. The Kan-Be Healthy program will not change and services for this program will be provided by the KanCare health plans.

14.  My daughter will need open heart surgery at Children’s Mercy within the next couple of years.  Part of that surgery might be considered experimental.  Is that covered?            
Currently Medicaid does not cover experimental treatments. The MCOs may choose  to cover the service based upon medical necessity and future standards of  practice.

15.  Specialty Medicaid provider is out of state, does Kancare address or cover these services?          
It depends on the specialty service. If it is a current Medicaid covered service, it will continue to be covered. If it can be provided in state, it will not be covered out of state based on preference only.

16.  We adopted our child through the court, (Child In Need of Care). What would happen if we move, if one of u gets a job out of the state?            
It depends on the type of adoption coverage your child received and what state you move to.   You should call your case worker to ask questions about the other state. 

17.  When all the kids in a home have a cold that requires antibiotics will parent be able to get medications so the kids don’t get sick again?    
This decision will be up to the physician or designee and based on medical necessity.

18.  Why doesn’t Medicaid/Medicare pay the VA?
If a veteran qualifies for Medicaid services, Medicaid will pay only for services not covered by the VA.

19.  Will birth control be covered on KanCare?     
Yes, family planning and reproductive health services will be covered under the plans.

20.  Will KanCare cover cataract care follow-up services?     
Yes

21.  Will KanCare pay for a podiatrist?                    
Yes, currently the coverage is for members 21 and under. With the implementation of KanCare, limited services will be available for members over 21. 

22.  Will KanCare pay for supplements that will improve recipient’s health?
Kansas Medicaid does not currently pay for nutritional supplements for adults, and only by exception for children.

23.  Will my options for services change?               
KanCare guarantees at minimum the current scope of services.  You may receive some extra services through the MCO.

24.  Will rules on ER visits change?                           
No.  You will continue to receive the same emergency services you receive today.  You should only go to the emergency room in a true emergency.

25.  Will terminal illness treatments be paid for?  Hospital stays also?             
Hospice care is available for the care of terminal illnesses. Once the member chooses hospice care, hospice will manage the plan of care.   The hospice provider will be responsible for hospitalizations related to the terminal diagnosis.

26.  Would doctors/specialists from out-of-state be covered?           
It depends on the specialty service. If it is a current Medicaid covered service, it will continue to be covered. If it can be provided in state, it will not be covered out of state based on preference only. The health plans will consider distance and transportation in out-of-state service requests.

27.  On limited services, does history of services transfer to KanCare?           
The State will share information with the MCOs about the services used by their members.  Whatever limits are in place for particular services will remain in place, unless an MCO wants to place FEWER limits on the service.  They can’t place MORE limits on services than what Medicaid currently has.

28.  How does the coverage work if we are out of state on vacation?             
If you have an emergency when you are out of state, you should go to the closest provider available in that area. Your health plan will pay for out of state services in an emergency.

29.  How will foster children KanCare be affected if adopted?           
This is a case by case situation. Some children are adopted and continue to get a medical card, some don't due to the agreement with the adopting parents or if they move out of state.

30.  I have Medicare, can I use my KanCare for services that are offered but not covered by Medicare?                                        
If you need a service that is not covered by Medicare, but is covered by Medicaid/KanCare, you can get that service through your KanCare health plan.

31.  If you are disabled and you need some home care, is there a change for that?  
A member, who requires home care, will need to work with their case manager to assure appropriate home care is provided to maintain their health and safety.  If you are currently receiving home care services, you can still receive those services in KanCare.  Services provided through the DD waiver will remain in the current system until January 2014, when they will become part of KanCare.

32.  What happens to supportive home care, day services, and residential services after one year?  
A member, who requires home care, will need to work with their case manager to assure appropriate home care is provided to maintain their health and safety.  If you are currently receiving home care services, you can still receive those services in KanCare.  Services provided through the DD waiver will remain in the current system until January 2014, when they will become part of KanCare.

33.  Will safety devices be covered? (handrails, ramps)        
Equipment that is covered today will still be covered.

34.  Does Medicaid currently cover hearing aids for the elderly? And will KanCare?
Hearing aids are currently covered for the elderly and will continue to be under KanCare.

35.  Handicapped accessibility modifications in the home? (i.e. bathroom modifications)
Home modifications are covered by some HCBS waivers; this will continue under KanCare.

36.  What is the monetary amount for dental/eyeglasses allotted for adults?
The MCOs will have contracts with providers which outline the reimbursement they will receive for services. From a member standpoint, the limitations will not be stated in dollar amounts, rather in terms of what services are covered and how often. An exception might be glasses frames; the providers may offer a selection that is within a certain price range.

37.  Will podiatry be covered? I need surgery but my podiatrist says he is not covered; he can give me a cortisone shot but it’s not a permanent cure.
KanCare will cover podiatric services, up to two office visits per calendar year. Prior authorization or care coordination may be required.

38.  Are audiology services covered like in Medicare? What about assistive devices like hearing aids?
KanCare will cover audiology services and hearing aids as currently covered by Medicaid. Our coverage may differ from Medicare, however.

39.  What does weight loss surgery mean? What services are with this? New services still being designed?
Weight loss surgery means a type of surgery also called bariatric surgery. This surgery helps people who have tried to lose weight in the past but could not. There will be specific criteria people will have to meet before they can receive this service.

Dental

1.  If I am not on Medicaid can I get the dental services the new system is providing?          
No.  You must be eligible for Medicaid to receive any benefits in KanCare.

2.  Is prior authorization required for oral surgery procedures? What about dental such as extractions, general anesthesia, biopsy and fractures?     
All services currently covered under Medicaid today, will be covered, at least at the same level, after January 1, 2013.

3.  What all will dental take care of?                      
For children, all dental services will be covered, as they are now.  For adults, the MCOs will provide a preventive dental benefit only.

4.  Will all dentists accept KanCare for adult preventative dental?  
We hope so.  The MCOs are working hard to sign up as many dentists as they can.

5.  Will sedated dental work be covered for those who cannot have dental services any other way? 
They have only sedated services now.  If the service is covered now in Medicaid, it will continue under KanCare.

6.  How will dental care be provided in nursing homes? Will it be a covered Medicaid service for nursing home residents?                                     
Adults will have access to yearly checkups, cleanings and x-rays. This includes adults in nursing homes.

7.  If you have a medical card, not Medicaid, will a person still be able to receive yearly routine dental care?
If you are not eligible for Medicaid or the Children's Health Insurance Program (CHIP), you may not receive any services through KanCare. It is a Medicaid program. If you are receiving Health Wave, you will be in KanCare. HealthWave goes away December 31, 2012 and KanCare takes its place January 1, 2013.

8.  Is dental care covered? How do you get dental care?    
Dental care for children is covered now in Medicaid and will continue in KanCare. Adults will be able to get yearly checkups, cleanings and x-rays in KanCare.

9.  Does adult dental care include periodontitis?   
No, it only includes yearly checkups, cleanings and x-rays.

10.  If you need a tooth removed, will they cover that?
Extractions that are currently covered for adults in Medicaid will continue to be covered.

11.  Can I get dentures with the new dental care?
No. Dentures will not be covered.

12.  What about adults who need to be hospitalized for dental work?
Each MCO is working with a dental services subcontractor. For Amerigroup and United, that is Scion Dental and for Sunflower, it is DentaQuest. These companies are working to sign up current and new dental providers for their networks.

13.  Does the dental service cover anything beyond the preventative services already mentioned? (i.e. fillings or crowns)
No. Fillings, crowns and other restorative dental work will not be covered for adults.

Developmental Disabilities (DD) Waiver

1.  What changes might those with DD expect in a year, and why are the DD waivers taking a year to switch?
Advocates for the Developmental Disability system were successful in securing a one-year implementation delay for HCBS Developmental Disability services.  This means the HCBS services under the DD waiver will not be provided under KanCare for one year and nothing will change for HCBS DD waiver services until 2014.  This includes Day, Residential and TCM services.  The physical health services for people on the DD waiver will be included in KanCare.  The physical health services under Medicaid will be provided through KanCare and through one of the health plans.

2.  How will someone with an intellectual disability competently choose a health plan even with others’ help? What will most likely happen is this choice will be made for him for his CDDO, and/or residential one-day services programs that is convenient for them?
Information will be provided to members directly and, if applicable, to the person’s guardian.  This information will be provided through direct mailings, website access and member-focused community meetings.  Members and guardians will be provided many opportunities to ask questions directly and indirectly over the next several months and after implementation.

3.  Please explain the pilot program for individuals with disabilities needed for the first year in the KanCare plan?             
The pilot program is an opportunity for individuals and providers of HCBS Developmental Disability Services or DD targeted case management to have those specific services included in KanCare. They will be able to participate in the development of KanCare for the those specific services.

4.  So, services for developmental disabilities will not be covered unless they are a part of a pilot program? If so, why? And what services are we referring?          
Advocates for the Developmental Disability system were successful in securing a one-year implementation delay for HCBS Developmental Disability services; including, but not limited to, Day, Residential and TCM services. These services will continue under the current system under January 2014, when they will become part of KanCare.  Pilot programs for these services will begin in KanCare during 2013, but these programs will be optional for consumers.

5.  Why the delay in services for individuals with developmental delays? Why did all other scenarios have a case coordinator except for DD?         
Advocates for the Developmental Disability system were successful in securing a one-year implementation delay for HCBS Developmental Disability services.  This means the HCBS services under the DD waiver and DD targeted case management will not be included in KanCare for one year unless the person chooses to participate in the DD Pilot Program.  Consumers on the DD waiver will retain their current targeted case manager, and will work with a care coordinator from the MCO if they have complex health needs.

6.  How will people with DD/intellectual disabilities be assisted to choose a health plan?  What provisions be made if a person with multiple doctors/specialists cannot find a health plan that covers all of them?
Individuals will initially be assigned to a health plan based on their current health providers. Members and guardians will be provided 90 days to choose another health plan and opportunities to change health plans annually, thereafter. Information will be provided to members directly and, if applicable, to the person’s guardian. This information will be provided through direct mailings, website access and member-focused community meetings. The state and MCOs will offer many opportunities to ask questions directly and indirectly over the next several months and post-implementation. In addition, people using DD services should get assistance from their case manager in obtaining and understanding information about the KanCare plans. Physical health providers will be encouraged to sign up with all three MCOs.

7.  Since the DD waiver services will not go into effect until 2014, will we still get a packet in November 2012 and have to make a change of providers prior to January 2013?
You will still receive a packet to choose a health plan for all of your non-waiver services. This would include things like your doctor visits and other specialists. You will receive the packet this fall and will have at least until February 14, 2013 to change.

8.  How does a DD person get into a pilot program?
Participation will be strictly voluntary for members. Information will be distributed that describes how a person can volunteer to participate in a DD pilot program.

9.  People on an HCBS waiver, the DD community will start KanCare Jan 1, 2014, what can we do between now and then to influence how that develops? We of the DD community have some real concerns about KanCare for our loved ones!
If you are interested in more directly engaging with the MCOs and learning about KanCare, you may want to participate in a DD pilot program.  You can also continue to engage in stakeholder information sessions and other learning opportunities, and information about them is available at www.KanCare.ks.gov.

Eligibility

1.  Current Medicaid states that the medical card stops if a youth is placed in juvenile detention whether it is for a day or not.  Is this going to continue and if so why?  The youth are innocent until proven guilty.  Sometimes it’s a CINC who comes to JDC so why would their med card cease?    
A child in custody under these circumstances will continue to be ineligible for medical assistance.  While the child in detention may lose eligibility for Medicaid coverage, the juvenile justice system will assume responsibility for medical care.  

2.  Does income level affect KanCare like HealthWave?      
Yes.  Consumers must still meet the income guidelines for the program.

3.  How will this affect kids turning 18?                 
There is no effect when a child turns 18.  KanCare will cover children up to the age of 19.  After age 19 their eligibility will be reviewed.

4.  Husband who just received disability will be eligible for Medicaid in 2013, reimbursement?        
An individual determined disabled by Social Security may be eligible for Medicaid right away if they meet all eligibility criteria.  Once they become eligible for Medicare, there are programs which may pay for the monthly premiums.  This does not change under KanCare.  

5.  I have low income and am over 21, am I eligible for KanCare?   
The general Medicaid eligibility guidelines are not changing under KanCare.  A low income individual over 21 may be eligible for Medicaid if specific program criteria are met.  Basic programs exist for individuals who are pregnant, disabled, elderly, or have families with children.

6.  Medicaid pays my Medicare A,B, and D premiums and gives me additional help paying for medications, will that change?                          
 No.  Your eligibility for coverage will not change under KanCare. Medicaid will continue to pay for the same things that are paid for now.

7.  What are the income requirements needed to qualify for KanCare?       
KanCare serves many different groups of people.  The income limit is different, depending on which group you are in.  You can find more information about the income guidelines on the DHCF web page. 
http://www.kdheks.gov/hcf

8.  What causes a person not to be in KanCare? What are the different levels of health care?           
Some Medicaid programs are not included in KanCare, such as Medikan, coverage for tuberculosis, and emergency services for non-citizens.  Consumers not in KanCare will continue to receive the same coverage they had before, on a fee for service basis. 

9.  Will KanCare have any effect on the timeliness of getting approved for Medicaid?          
The application process for Medicaid is not changing with KanCare.  An application for assistance will still be required to be processed within 45 days from the date of receipt.   

10.  Will the qualifying guidelines change for people to receive KanCare?     
No

11.  Will the local office for Medicaid stay at the State office building?          
Yes.  Medicaid eligiblity will still be determinedby the State and there will continue to be local offices.

12.  How will paperwork be handled after 2013 when eligible folks can choose their own plan?

Just about the same as it was handled in 2012. In 2013 if they are applying and know which KanCare plan they want while they are in “application pending” status they can choose at that time and will be assigned the KanCare plan of their choice from the beginning of their coverage.

Home and Community Based Services (HCBS)

1.  Will this change the length of the waiting list for HCBS or give any hope that assistance may actually be available in a reasonable time?    
KanCare may have an indirect impact on the PD wait list; however, a number of efforts are underway by the state currently to establish informed resolution to the issue.

2.  My 13 year old daughter is on the waiver through the mental health center.  Will she be kicked off that?
No.  The waiver services that are in place for your child will still be available under KanCare. 

3.  What about TA waiver kids?  Did they get missed yet again?      
All technology assisted waiver services are included in KanCare and all services currently covered must continue to be covered by the MCOs.

4.  Will we be able to self-direct our child’s services as we do now?
Yes

5.  I’m HCBS self-direct, my case manager tells me that under some circumstances if my husband’s care giver cannot care for me, or he has surgery, I can go to a rest home for short term care.  Would that also apply if the burden of my care would cause such stress in him that his behavior toward me would adversely affect my health, or put me in danger?      
If you and your husband are receiving HCBS self-directed services, you should each have your own Personal Attendant. Your husband should have a back-up plan should his Personal Attendant be temporarily unavailable. Should you ever experience the threat of harm or threats to encourage you to obtain additional services, please call Adult Protective Services, immediately. Adult Protective Services hotline: 1-800-922-5330

6.  Will we be able to self-direct our child’s services as we do now?              
Yes

7.  Will I be able to direct my own care? 
Mental and physical.    All services that can currently be self-directed will continue to be.

8.  My son is on the TA waiver.  He has complex case and receives care at Children Mercy Hospital and has a PCP.  We as parents manage his care, how will the case manager change that?       
You still have the option to manage your son’s care and he will continue to receive all Medicaid services he receives, today, through KanCare.  Your situation as described here is one that would benefit from the comprehensive care management resource that will be available at each of the KanCare plans.  They will help you fully understand your son’s service needs and options, access necessary care, and coordinate all relevant care and information.

9.  Who pays for day services for someone going to a community based services (such as Lake Mary Program) during 2013?
Day Supports are HCBS DD waiver services and will continue to be provided as they are currently.

10.  How do I know what waiver plan I am on?
Each waiver program has specific eligibility criteria, as each is designed to meet needs of individuals that have functional impairments due to a disability or other condition. Whichever waiver you are eligible for is the waiver you would use; and if you are currently using a specific waiver program, that program will continue and all existing services will continue to be available.

11.  Will there still be a waiting list for PD waiver? Crisis Exception?
Yes and yes.

12.  What changes will come on Plan of Care when it is reviewed for HCBS?
The MCOs will become primarily responsible for plans of care, and ensuring that each person’s necessary services are identified and addressed.

13.  Explain the HCBS waiver programs. Who is covered or affected?
There are seven HCBS waiver programs in Kansas, and they vary significantly. You can find information about each waiver at the website of the Kansas Department for Aging and Disability Services, www.kdads.ks.gov.

Health Homes

1.  If you have qualities for LTC now, can MCO choose to place you in a health home?        
A health home is not an actual building.  It will be one provider among several that you have who coordinates everything related to your health care.

2.  Can you please explain how health homes and each member of the team stay current with an individual’s information?  For example, if an individual has a change in health, how will each member be updated on the changes?            
One component of health homes is health information technology (HIT).  Whichever provider becomes the health home, they must be able to share information back and forth to make sure everyone is current on what is happening with the patient.

3.  Not sure I understand how a “health home” is different from “wrap around” services? 
A health home is one provider who takes responsibility for coordinating and managing all the other services the person receives and makes sure everyone is communicating with one another.  In addition, the health home must make sure discharge plans are in place before a person leaves an inpatient setting, that a care plan is developed, and that the person has all the information he or she needs to participate in managing their conditions.

4.  Please explain the health home idea.              
A health home is one provider who takes responsibility for coordinating and managing all the other services the person receives and makes sure everyone is communicating with one another.  In addition, the health home must make sure discharge plans are in place before a person leaves an inpatient setting, that a care plan is developed, and that the person has all the information he or she needs to participate in managing their conditions.

5.  What are health homes?                                     
A health home is one provider who takes responsibility for coordinating and managing all the other services the person receives and makes sure everyone is communicating with one another.  In addition, the health home must make sure discharge plans are in place before a person leaves an inpatient setting, that a care plan is developed, and that the person has all the information he or she needs to participate in managing their conditions.

6.  Who assigns my health home or how do I decide who that is?  
If you are eligible for a health home, you'll be assigned to that based upon your condition and your individual network of providers. Your health plan will make the assignment.

HealthWave

1.  Why is HealthWave going away?             
The State's contracts with HealthWave plans are ending. All consumers in the HealthWave program will be assigned to the KanCare program starting January 2013. Members can choose their new MCO from the three plans offerred.

ID Cards

1.  Will there be a new card from the MCO with the same Medicaid #?        
Yes.  Each consumer will receive an ID card from their health plan that clearly identifies the MCO they are assigned to.  The consumer's Medicaid ID number will also be on the card, and will not change.

2.  Will there be a new card from the MCO with the same Medicaid #?        
Yes, each MCO will have their own medical card with their own design and the KanCare logo on it.  This card will continue to have the Medicaid ID number on it.

3.  Do I present the KanCare card if I am going to the dentist or eye doctor?            
Yes.  The card should be presented anytime you get any medical service.

KanCare General Questions

1.  KanCare will start Jan. 1, 2013. But for the people who cannot enroll before then, will the old Medicaid still cover them?                                  
People who are in Medicaid now will receive services under the old Medicaid system until January 1.  People who are new to the program between now and January will be covered by the old program until January and will become part of KanCare on January 1. People who become eligible after January 1 will be a part of KanCare as soon as they are eligible for Medicaid.

2.  How will the external reviews measure and publish their assessment of meeting outcomes?       
The health plans will be fully reviewed by the State to see if the quality and access to care measures were met.  An External Quality Review Organization will also make a yearly review of each health plan.  The results will be published broadly. This will include giving information in consumers' annual open enrollment packets, and publishing the results on the website and in other media.

3.  How will repeat hospital admissions be stopped?           
MCO care coordinators will work with the member, their family, if appropriate and all providers to ensure there is a discharge plan that will help the member get appointments, medical tests and other services to prevent repeat hospitalizations.  Members with serious chronic conditions will be helped to manage those conditions better and get the recommended care to avoid having to go to the hospital.

4.  How will state measure quality of life? 
Just because an individual is getting needed medical services and appropriate tests doesn’t mean they have quality of life in terms of personal preferences and individual rights. The State is required by the federal government to have a quality improvement strategy.  This is Attachment J of the KanCare RFP which can be found here.  This strategy includes several quality of life measures that the MCOs will be responsible for meeting.  Throughout the RFP, the State stressed a person-centered approach and will expect MCOs to adopt that approach as they work with members.

5.  What part does KanCare play vs. state Medicaid?          
KanCare will be the Medicaid program for almost everyone.

6.  What was the vetting process used in picking the 3 MCOs?        
Five companies bid on the request for proposal the State issued.  Over 65 state staff reviewed the proposals and provided comments.  More than a dozen state staff negotiated with the five companies and then selected three based on how well they could do what we wanted and the costs they proposed.

7.  How is managed care going to improve access to care providers?           
The State will require that the health plans meet certain access standards. The health plans will have more ability to pay providers different rates that could encourage them to sign up. The health plans can also use different technology to provide access in remote areas. This could include things like telehealth and telemedicine.

8.  How were these three groups chosen?           
Five companies bid on the request for proposal the State issued.  Over 60 state staff reviewed the proposals and provided comments.  More than a dozen state staff negotiated with the five companies and then selected three based on how well they could do what we wanted and the costs they proposed.

9.  I am only on the LMB program.  How will this change my services?  Do I need to select a plan?  
No. Consumers on the LMB program only will not be a part of KanCare.

10.  If I have a complaint that KanCare plan’s customer services rep does not settle to my satisfaction, who do I go to?           
If you have a problem with customer service at your health plan, you can contact a member advocate that will help you file a grievance. If the complaint is still not settled to your satisfaction, the member advocate will help you file a grievance with the State.

11.  How will KanCare be affected by the outcome of the implementation of Obamacare for the State of Kansas?
KanCare will not be affected by the provision of the Affordable Care Act. Medicaid services will continue to be provided as described under KanCare.

Managed Care Organizations (MCOs )

1.  Are there any of the 3 health plans out of state?            
All three of the KanCare health plans are national companies.  They have provided similar services to consumers in other states. Each plan must have a local office in Kansas where consumers can call for help.

2.  Sunflower mentioned a call center. Where will it be located? And where is their local office located?                        
The call center will be located in either Johnson or Wyandotte County. Sunflower's current office is in Wichita, and they will continue to have an office there.

3.  Will your MCO be the same person when you have a problem to talk about?      
If you have a question, you should first talk to someone at your MCO (health plan).  If you get a care coordinator, they will be the person you talk to first.  You can also call the health plan's customer service center.  If the health plan does not help you with your problem, you can file what is called a grievance, or complaint.  Each health plan will have someone called an advocate that can help you file a grievance.

4.  Can I be dropped by the plans?

No. The health plans must serve all patients who choose or are assigned to be in their plan.

MediKan

1.  Will Medi-Kans be assigned an MCO?             
MediKan is a state funding only program and is not part of KanCare.                                                                                

Member Advisory Council

1.  Will the member care Advisory Board actually have power to direct the plan or simply be rubber stamps with no power?
The plans are required to have a Member Advisory Council with meaningful stakeholder membership. The State will evaluate the input MCOs receive through their advisory council's and how that input is shared in their company and acted upon.

2.  How can consumers get a chance to be on the "advisory group" or such?
Consumers should reach out to their MCO after January 1 to get involved in the member advisory council.

Mental Health

1.  Also peer run respite services save money versus hospitalizations. Will this become a real option for mental health clients or must we always be hospitalized when we or our caregivers need a short respite?               
The current array of mental health services available to Medicaid beneficiaries will remain the same under KanCare.   In addition, the KanCare plans are making "value added services" available for members in their plan, and in some cases that includes respite services.  Certainly, the use of peer support services in this role would be consistent with the goals of strong personal outcomes.

2.  How will KanCare improve access to acute psychiatric services both for children and adults?      
The purpose of KanCare is to effectively meet the needs of all Medicaid members in the most effective way that will support strong personal health outcomes based upon each member's unique health care needs.

3.  Regarding mental health services, will peer support services (Certified Peer Specialist) at the CMHCs be expanded so that more people can access the services?        
The use of peer support services is a strong preference for all mental health stakeholders, and that preference has been clearly articulated to the new KanCare plans.

4.  What’s required to receive mental health services?       
An individual must be diagnosed with at least one "mental disorder" as defined by the current Diagnostic and Statistical Manual for Mental Disorders (DSM-IV-TR) and be in need of services that will be effective to help them address their current needs.  Based upon an evaluation of the current needs, our goal is that the right service will be delivered at the right time and place to most effective address the current need.

5.  Will KanCare have group homes for mental illness patients need help with ordering and picking up medicine?                     
The current array of mental health services available to Medicaid beneficiaries will remain the same under KanCare.   In addition, the KanCare plans are making "value added services" available for members in their plan, and issues such as this may benefit from those services.

6.  What’s required to receive mental health services?       
An individual must be diagnosed with at least one "mental disorder" as defined by the current Diagnostic and Statistical Manual for Mental Disorders (DSM-IV-TR) and be in need of services that will be effective to help them address their current needs.  Based upon an evaluation of the current needs, our goal is that the right service will be delivered at the right time and place to most effective address the current need.

7.  Will KanCare have group homes for mental illness patients need help with ordering and picking up medicine?                     
The current array of mental health services available to Medicaid beneficiaries will remain the same under KanCare.   In addition, the KanCare plans are making "value added services" available for members in their plan, and issues such as this may benefit from those services.

Misc.

1.  How is food assistance going to change?       
Food Assistance is not changing.  That program is administered by the Department for Children and Families (DCF).  More information about food assistance can be found at www.dcf.ks.gov

2.  So, the plans replace Medicare D for individuals on Medicaid and Medicare in a skilled care facility?                          
No, if you are eligible for Medicare Part D, KanCare will not pay for your prescriptions.  Medicare Part D will continue to pay for your drugs.

3.  Why are we told to get the information online when those receiving Medicaid have very limited access to computers?
The State has made efforts to provide information to consumers in a variety of formats so that it is accessible to all.  This includes in-person educational meetings, phone numbers to contact with questions, and information online.

4.  Will there be external reviews?  How will the results of these be communicated to us?   
Yes.  The health plans will be fully reviewed by the State.  An External Quality Review Organization will also make a yearly review of each health plan.  The results will be published broadly. This will include giving information in consumers' annual open enrollment packets, and publishing the results on the website and in other media.

5.  Will we still need to choose or change plan D in October?
Yes.

6.  Will any presentations of KanCare be offered to senior providers who work with current consumers?
Yes.  KDADS held informational meetings the last two weeks in August for providers who work with older consumers or consumers with disabilities or behavioral health issues.

7.  Will the hospital change?                                    
MCOs are required to do everything they can to sign up all hospitals currently in Medicaid.  Payment rates will be the same.

8.  Will KanCare pay for “extra help” that Medicaid pays for now?               
This person may be asking about in-home services.  If those are covered now in Medicaid, they will be covered in KanCare.

Money Follows the Person

1.  How will KanCare affect-Money follows the person program?
The MFP program will continue under KanCare. Care coordinators from the health plans will be responsible for assisting nursing home residents who wish to move to a less restrictive environment do so safely.

Nursing Facilities

1.  If a recipient is in a nursing home and will not be returning home, what new benefits will KanCare have for me?
KanCare has added heart and lung transplants, weight loss surgery, adult preventive dental, and a variety of value added services unique to each health plan. Additional information on benefits is available here: http://www.kancare.ks.gov/benefits_services.htm.

Other Insurance

1.  How does KanCare fit with a Medicare Advantage HMO through, say Humana?
Your Medicare Advantage HMO will continue to be the first payer of your medical expenses.  KanCare will work as a Medi-gap plan.

2.  I have a relative on Medicare and Medicaid, how does Coventry dual eligible MA plan work with KanCare? KanCare will remain the payer of last resort.  The process will remain the same as it currently is.  Medicare will pay first and Medicaid (KanCare) will pay second.

3.  If you have a commercial insurance as primary and KanCare as secondary, are you still required to follow KanCare rules regarding choice of PCP and hospitals?     
Yes.  Benes are required to follow KanCare rules regarding PCP and hospitals.  However, the MCO must make every effort to arrange for the member to continue with the same provider.  In cases where primary insurance does not cover a service, KanCare will pay primary and the MCO will pay and chase the other insurance.

4.  How does KanCare dovetail with my special needs son's current primary provider? (KS Medicaid is currently his secondary provider-primary for skilled nursing services)
KanCare will still be a secondary insurance. You will still need to pick an MCO plan. If your primary provider is not in a KanCare MCO they could still bill as an out of network Medicaid provider. The KanCare plan would then pay 90% of what Medicaid would have paid.

5.  Would anyone on KanCare need a supplemental insurance coverage (like BCBS)?
Perhaps, it is an individual’s decision about whether KanCare will meet all their medical needs or not.

6.  Do I need to purchase a Medicare supplemental plan?
KDHE does not make suggestions on if a person needs a Medicare supplemental plan. I encourage you to speak to a SHICK counselor at 1-800-860-5260.

7.  My 38 year old son who lives with me and has special needs has a health insurance policy through Humana for $20/mo with co-pays. Should I let it lapse and choose one of the 3 new ones instead?
KDHE does not make suggestion on if a person should drop health insurance policies. I encourage you to speak to a SHICK counselor at 1-800-860-5260.

8.  My mother is on Medicare and Medicaid and has a deductible early in the year. Medicare doesn't pay for doctors visits until her deductible is reached. In the past, Medicaid has reimbursed her for her doctors visits, will they still under KanCare?
Correct, KanCare will still cover Medicare deductibles for your mother as it does now.

9.  If a person has private primary insurance, how does the MCO case manager not duplicate services with the private carrier case manager (with complex medical cases)?
The two case managers will need to work with each other, which will be in the best interest of all involved when they do.

Pay for Performance

1.  In what ways will you hold providers responsible for health outcomes? All I am hearing is the benefits of this new program. What are the disadvantages? How is this going to save money?     
The MCOs will be held accountable for health outcomes through the health quality measures, 15 of which have significant monetary awards tied to them.  MCOs will save money by improved coordination of care that increases member health and directly reduces the need for medical services.  In future years this will lead to lower costs for the program as a whole.

Payment

1.  Is funding for nursing homes going to be reduced?       
No, reimbursement rates for nursing facilities are not being reduced with the transition to KanCare.

2.  How is the state going to guarantee timely payments of providers to avoid the problems of extreme financial compromise of providers in other states that have initiated managed care for Medicaid?                     
Through claims aging reports and audits the MCOs are required to pay all clean claims with 30 days, 99% of non-clean claims within 60 days and all claims including adjustments within 90 days.  See RFP Section 22.38 for Timely Claims Processing details. 

3.  How will providers under contract be paid?  Per capita?              
Providers will be paid FFS by the MCOs unless they negotiated another payment method that is approved by the State.

4.  How will providers be reimbursed for increased billing/administrative requirements of dealing with three MCOs?                
Providers will be paid FFS by the MCOs unless they negotiated another payment method that is approved by the State.

5.  Does KanCare change how providers bill for services?   
Providers have the option to bill through an established commercial clearinghouse, through the State's single billing interface (MMIS) or to send their claims directly to the MCOs.

6.  Will each MCO be working with clearinghouses for billing or will they have an electronic submission options of their own?                     
Yes.  All the MCOs do offer electronic submissions options.

Pharmacy

1.  Are you considering a mail-in pharmacy?        
MCOs have the option of offering a mail order pharmacy benefit to KanCare beneficiaries. However, MCOs are not allowed to require beneficiaries to receive their medications through the mail.

2.  My son has epilepsy, when we lost my husband’s insurance we were made to go get generic drugs.  Will that be the same?  My son does better on the brand name drugs, but without insurance we don’t have a choice.
There is a process where a beneficiary’s physician can complete a request for brand name medication. Provided that the prescriber and pharmacy can coordinate this process, a beneficiary can receive a brand name medication if it is medically necessary.

3.  My son is taking ADHD med which, Medicare and Medicaid will not pay for because it is not generic.  Will KanCare cover it?                           
Yes, KanCare plans are required to cover all mental health medications without limitations. Further, MCOs will continue to cover medications that are currently available to Medicaid beneficiaries.

4.  Prescription relief, will it work?                         
The consumer who asked this question was referring to a prescription discount card that helps with pharmacy expenses. In KanCare, there will be no copay on any prescription claims, so consumers should not have a need for discount cards. Additionally, many of these cards cannot be used with Medicare or Medicaid plans.

5.  What if my prescription is from a doctor who is not covered or in the group, a specialist? Will my prescription be covered?                                      
The cost of a beneficiary’s prescription will still be covered by their MCO plan even it has been written by an out-of-network or non-contracted provider.

6.  What is pharmacy copay structure for all Consumers from each of the managed care plans?        
There are no pharmacy copays.

7.  Will all pharmacies accept all plans?                  
Pharmacies will only accept those plans that they are contracted with. We are encouraging current Medicaid pharmacy providers to contract with each of the three MCOs.

8.  Will prescription coverage be included in the MCO plan?              
Yes, each MCO is required to offer a pharmacy benefit.

9.  Will prescriptions still be on the same part D or will we change?  
Medicare pharmacy benefits through a beneficiary’s Part D plan will not change.

10.  Are you considering a mail-in pharmacy?      
 MCOs have the option of offering a mail order pharmacy benefit to KanCare beneficiaries. However, MCOs are not allowed to require beneficiaries to receive their medications through the mail.

11.  Will prescription coverage be included in the MCO plan?              
Yes, each MCO is required to offer a pharmacy benefit.

12.  Will prescriptions still be on the same part D or will we change?    
Medicare pharmacy benefits through a beneficiary’s Part D plan will not change.

Premiums

1.  Will this affect premium amount?                    
Your premium payment will stay the same as long as there are no changes in your income level.

2.  I have Medicare and Medicaid. I never meet my spendown. Medicaid pays my Medicare part B premium. Will KanCare continue to pay my Medicare part B premium?
KanCare will continue to pay Medicare Part B premiums as it does currently

3.  Will they change how they pay the part B of Medicare?              
No

4.  Medicaid pays my Medicare A,B, and D premiums and gives me additional help paying for medications, will that change?                            
Medicaid will continue to help with payment of Medicare copays. The MCOs are also required to pay copays on prescriptions after your Medicare Part D plan has paid.

5.  What is the monthly health care insurance premium?
Not all KanCare cases will have premiums. It all depends on the type of coverage and the income level of the person applying. A person would need to apply for KanCare to see if they will have a premium.

Provider Network

1.  Will my doctor get a letter about KanCare?   
Yes.  The MCOs are working hard to sign up all the current Medicaid doctors.

2.  College student attending ESU in emporia:  will you give her a list of doctors there in case of an emergency?
She can check the list of providers in Emporia when choosing a plan.  The plan she chooses can also help her find the providers she needs in Emporia in advance.

3.  If primary doctor is on vacation who can I go to?           
It is required that a physician designate an on call physician as a back-up.

4.  Will there be marketing incentives for doctors to become providers?    
MCOs must pay doctors at least 100% of the fee for service rate.  Beyond this plans are free to incentivize providers to expand their network. 

5.  In the past doctor’s dropped patients because they can only take a certain number of clients, will that continue to happen?                                   
The health plans will do everything they can to build a large network of providers (like doctors) to serve their consumers.  They cannot force doctors to take patients, but they can make sure there are enough doctors in their network to get all consumers the care they need.

6.  If current doctor isn’t signed with one of the plans, can they get into the plan? 
Yes, the provider would need to contact the MCO and follow their enrollment process.

7.  What happens if the current physician or the various specialists are not on any of the plans?     
If a provider is not enrolled with any of the plans but the beneficiary is enrolled with a MCO the beneficiary will still be able to go to the provider or specialist but at a lower reimbursement rate because the provider would be considered out of network.

8.  What if all of my providers are not in the same plan network? Will I still be able to see them?     
Yes.  You can still see providers that are out of network.  But, the provider won't be paid the full amount for the service.  They might bill you for the amount that isn't paid, but they must tell you ahead of time they are not in the network and will bill you for the unpaid amount.

9.  What if my father’s nursing home is not enrolled with a provider that supports his complex medication regime? Will he be forced to change nursing homes?            
Consumers can still use providers that are out of network.  But, the provider won't be paid the full amount for the service.  They might bill the consumer for the amount that isn't paid.

10.  What if no doctor in a rural area decides to be a provider?         
The MCOs are reaching out to the rural providers to encourage them to enroll.  The state is also providing educational tours to update providers on the transition to KanCare.

11.  What if we can’t get all needs on any one provider?      
Consumers can still use providers that are out of network.  But, the provider won't be paid the full amount for the service.  They might bill the consumer for the amount that isn't paid.

12.  You keep saying participants can keep their current service providers, what if they have a variety of providers and not all those providers contract with the same insurance providers?    
Consumers can still use providers that are out of network.  But, the provider won't be paid the full amount for the service.  They might bill the consumer for the amount that isn't paid.

13.  I live in north central Kansas, why do the providers have to be so far away for dental?  
Currently, fewer dentists sign up for Medicaid than other providers.  Also, there are simply not enough dentists practicing in Kansas.

14.  Will there be more providers willing to accept new clients?  Currently there are no dentists in Dodge City willing to accept new clients but are listed as providers in the plan.  
The MCOs are currently trying to enroll providers within their networks and the state will be working with the Dental Association and doing special outreach to the dental provider community.

15.  You mention trying to get more providers, how so?      
Working with the MCOs and continuing provider outreach and education.  Also encouraging providers to enroll with all three MCOs.

16.  Will there be doctors, dentists, dermatologists, chiropractors, and all other doctors that will take KanCare?  Most people on KanCare cannot afford to drive to Kansas City, Topeka, Wichita, etc.  The doctors here in Hays are greedy and very independent.  Will we be forced to do what the care-takers here say?          
The MCOs must try to sign up all current Medicaid providers.  They will make sure there are doctors available for their members and will provide transportation to members to appointments.

17.  How will KanCare encourage more physicians to participate?    
The MCOs are required to offer contracts to all existing Medicaid providers and to demonstrate that they have enough providers throughout the state to meet everyone's needs.

18.  When and where are lists of participating providers (primary doctors, dental, etc) for each plan available?
Each MCO will have a list of their network providers on their website.

19.  What if your doctor is not available? Can you see another doctor within the same clinic?
You can see any doctor that is part of your health plan's network. You will need to see where your current providers are enrolled when you get your packet this fall.

20.  Will there be a list of all doctors accepting KanCare?
Yes. You can call your doctor, the MCO, or the KanCare customer service line after you receive your packet to receive a list.

21.  Will surgeons and anesthesiologist accept KanCare patients?
Yes. The MCOs are required to have a network of providers to cover all specialties.

22.  What percentage of doctors will accept KanCare patients?
Hopefully all doctors that are currently accepting Medicaid and more. It is always the doctor's choice, but we have told the MCOs that they have to try to get all current doctors to sign up.

23.  What happens if your regular doctors aren't signed up in the program by November?
If your doctor signs up after November, you can still change to the plan(s) they are in for at least 90 days after January 1st. If your doctor does not sign up at all, you can continue to see them until your health plan can transition you to a new provider that can meet your needs.

24.  What will out of network services cost if my doctor isn't on the plan I'm assigned to or any of the other plans?
If your doctor wants to see you as an out of network provider, they will have to accept a lower payment from your health plan. Your doctor cannot charge you the difference between what they would have received as an in-network provider and what they receive as out-of-network.

25.  My primary PCP only accepts Medicare; will I be forced to change to a Medicaid provider? And forced into a managed care since I have several diagnoses? I manage very well.
Your health plan will coordinate with your Medicare providers. You will be in KanCare, but will not be forced into any care or disease management programs if you do not want to participate. Your health plan will tell you how they believe they can help, and offer you options to better manage your care if you think they could benefit you.

26.  It is my understanding that a Medicaid provider may not choose to be a KanCare provider. What system is in place to keep an adequate number and the necessary providers in the KanCare system?
Each of the three plans must offer participation in their network to all current Medicaid providers. Providers can choose not to participate, but the plans must meet certain network adequacy standards. This may mean they have to negotiate contracts that are more favorable to providers to get them to sign up.

Referrals

1.  If a child is assigned to a certain provider and goes elsewhere, will they need a referral?              
In most cases, no. None of the three KanCare health plans will require referrals to specialists. If you would like to change your primary care provider (PCP), the health plan would like to have a record of that, but will not require a referral if you go to another provider who is in the plan's network.

2.  I want to see a specialist—my doctor disagrees—the specialist wants a referral, how do I get around this wall?  Keep up pressure on my doctor or my care manager?             
When you are assigned a care manager or care coordinator in KanCare they will be able to help coordinate your care for you.  They can also help you talk with all of your providers about your needs.

3.  Will PCP’s have to refer for a visit to a specialist every time or just the initial visit?             
A PCP can give a referral that can be in effect up to 6 months.

4.  What about referrals for doctors out of the state?         
A member seeking care out of state will need to work with their PCP and their MCO to assure the Out of State service is a covered service.

5.  What does an individual do if a provider refers you to a specialist that is not aligned/signed up with your health plan company?                      
The member needs to contact their MCO for assistance. If you see a provider that is not signed up with the MCO, that provider will be paid less and may bill you for the additional amount.

6.  I want to see a specialist—my doctor disagrees—the specialist wants a referral, how do I get around this wall?  Keep up pressure on my doctor or my care manager?             
Referrals for specialty care are not required.  You must stay in your MCO’s network of providers

Savings

1.  How is paying for all these “care managers” going to reduce costs?        
The State is paying each health plan a set rate to provide all of the care their members need. The rates the State pays to the health plans are designed to ensure savings for the State. The contracts also have measures in place that will ensure the plans do not cut services or provider rates to save money. The plans are expected to coordinate the care that their members receive. This means they are responsible for making sure people get preventive care early, before the patient gets sick and needs more expensive care. Over time, this will lead to reduced costs.

2.  What are you going to do with the money you save? Do we get it back? How does this plan save money? The State is paying each health plan a set rate to provide all of the care their members need. The rates the State pays to the health plans are designed to ensure savings for the State. The contracts also have measures in place that will ensure the plans do not cut services or provider rates to save money. The plans are expected to coordinate the care that their members receive. This means they are responsible for making sure people get preventive care early, before the patient gets sick and needs more expensive care. Over time, this will lead to reduced costs.  The Kansas Legislature will decide how to allocate any direct savings fromt the program.

3.  With all these additional services and staff, how will Medicaid keep from continuing to operate on a deficit?
The State is paying each health plan a set rate to provide all of the care their members need. The rates the State pays to the health plans are designed to ensure savings for the State. These rates include the plans' administrative costs and the managed care discount. There is also a risk sharing element in the contracts that ensures the health plans will not exceed a certain percentage in profit. The contracts also have measures in place that will ensure the plans do not cut services or provider rates to save money. Consumers must receive the same level and quality of services they are receiving now, or the health plans will face penalties.

4.  How is managed care going to save Kansans money?   
The State is paying each health plan a set rate to provide all of the care their members need. The rates the State pays to the health plans are designed to ensure savings for the State. The contracts also have measures in place that will ensure the plans do not cut services or provider rates to save money. The plans are expected to coordinate the care that their members receive. This means they are responsible for making sure people get preventive care early, before the patient gets sick and needs more expensive care. Over time, this will lead to reduced costs.

5.  How will the money saved be used?  Will it be put toward reducing individuals on the waiting list? 
KanCare may have an indirect impact on the PD wait list; however, a number of efforts are underway by the state currently to establish informed resolution to the issue. The Kansas Legislature will decide how to allocate any direct savings from the program.                                       

6.  If Medicaid state administrative costs are 2 to 3 percent and private insurance administrative costs multi times more, including CEO bonus, how can we believe benefits won’t be cut?       
The State is paying each health plan a set rate to provide all of the care their members need. The rates the State pays to the health plans are designed to ensure savings for the State. These rates include the plans' administrative costs and the managed care discount. There is also a risk sharing element in the contracts that ensures the health plans will not exceed a certain percentage in profit. The contracts also have measures in place that will ensure the plans do not cut services or provider rates to save money. Consumers must receive the same level and quality of services they are receiving now, or the health plans will face penalties.

School Based Services

1.  Will children with learning disabilities still be able to qualify to receive all extra help in school and will the schools still receive funding for those children?
Yes. All the services children receive through a school now will still be covered. The school will coordinate with the child's health plan as needed.

2.  Will the services provided by the school change due to KanCare?
No.

Spenddown

1.  Will spend-downs still exist?                               
Yes.  Eligibility rules are not changing.

2.  Explain PIL and why my spenddown is so high?              
PIL is short for Protected Income Level.  The PIL is the amount of income the individual is allowed to shelter in determining medical assistance.  Any income in excess of the PIL is considered available to meet medical needs.  The more income exceeds the PIL, the higher the spenddown amount.  The current PIL for the spenddown program is $475/month.  The spenddown period is generally 6 months.  Multiply the monthly amount income exceeds the PIL times 6 to determine the total spenddown amount for that period.  The spenddown works like a deductible with regular health insurance.  There is no medical coverage until the individual has incurred enough bills to meet the spenddown.  Once the spenddown is met, any additional bills may then be covered.

3.  I’m unable to see orthopedic and mental health doctor, due to spenddown, is there anything that can be done?               
KanCare does not  change the current spenddown process.  Until the spenddown is met, no services will be covered.  You may still see medical providers and have them bill against your spenddown until it is met.

4.  Is so, how much will spenddowns decrease or increase?             
 The spenddown will continue to be the amount your monthly income exceeds the Protected Income Limit (PIL) over a 6 month period.

5.  Will there still be expensive spenddowns?             
KanCare does not change the current spenddown process.  The spenddown will continue to be based on the amount your income exceeds the Protected Income Limit (PIL).  The more your income exceeds the limit, the higher your spenddown will be.

Transportation

1.  Can a member choose which transportation provider they ride with?    
Probably not.  However, if a member has special needs, the health plan will need to consider those needs when setting up transportation for the member.  Each of the three health plans has said they will allow the member to choose their provider in certain situations.  This might include situations where a mental illness or other condition makes it important for a member to ride with a certain transportation provider.

2.  Can I still get rides to Kansas City for appointments?     
If you need to see a doctor in Kansas City for a service that is covered by Medicaid, you can still get a ride.  You will schedule your ride through your KanCare health plan.

3.  How do I locate the “transportation program” to medical appointments?           
When you choose your health plan, there will be a number you can call to ask the health plan about any questions you have.  The health plan will be able to help you get transportation services.  If you have a care coordinator through your health plan, this person will be able to help you as well.

4.  How does the transportation assistance to medical appointments work?  Is it only for wheelchair patients? Transportation to medical appointments is covered by Medicaid.  If you need to see a doctor for a service that is covered by Medicaid, you can get a ride to that appointment.  Your health plan will ask you what your transportation needs are when you call to schedule a ride.  In some cases, they will give you gas money to drive yourself to an appointment if you are able to.  You can also get gas money for a friend or family member to drive you.  If you cannot drive yourself and need someone to come pick you up, your health plan can send a ride for you.  If you have a wheelchair or other mobility issues, they will send a ride that can take care of those needs for you.

5.  How is transportation provided for out of town providers?        
If you need to see a doctor or other provider in another town, you can get a ride from your KanCare health plan.  In some cases the plan may require you to go to the closest provider that can meet your medical needs.  Transportation can mean that the plan will send a car or van to pick you up. It could also means that the plan would give you gas money for you to drive yourself or have a friend/family member drive you.

6.  I drive my brother to dialysis 3 times a week and to have fluid removed every 2 weeks.  I donate time at Salvation Army to save gas.  I am happy to do this; can I get gas money or gas to help out?  I am also on disability.                                         
The KanCare health plan will cover transportation to medical appointments for your brother.  He should contact his health plan once he is assigned.  The health plan will give him the forms and information he needs to get reimbursed for mileage to dialysis.  He can choose to have you drive him and receive reimbursement.  You will just need to verify the trips in advance with the health plan and fill out a trip log and other paperwork.

7.  Transportation assistance for appointments:  After medical spenddown met or at any time under the KanCare plan?      
Transportation will be provided to medical appointments after your spenddown has been met.  It will be provided through your KanCare plan.

8.  What transportation is available for a client located in a small town 40 miles from his specialist?                                        
If you need to see a specialist in another town, you can get a ride from your KanCare health plan.  In some cases the plan may require you to go to the closest provider that can meet your medical needs.  Transportation can mean that the plan will send a car or van to pick you up. It could also means that the plan would give you gas money for you to drive yourself or have a friend/family member drive you.

9.  Will KanCare cover transportation services like MTM for out of state appointments?     
If the patient has an established care provider out of state, we will likely want to have that care continue. We understand that for certain areas of Kansas, out of state providers are the closest option for certain types of care.  If you need to see an out of state provider, you might have to get a referral from your health plan. 

10.  Will MCOs pay for transportation?                   
Yes.  The health plans will be required to provide transportation to any appointment that is covered by Medicaid.  Each of the health plans is using a transportation broker, which is a company that will help the plans set transportation for their consumers.

11.  Will Medicaid transportation be expanded in rural Kansas and if so, by how much?        
Each health plan will be required to meet certain access standards.  If there are not enough transportation providers in a rural area to serve all consumers, the health plan will expand.  How much they expand will depend on the needs of consumers and what providers are available currently.

12.  Will the transportation mileage reimbursement be a benefit on these MCOs?    
Yes.  Each of the plans will provide mileage reimbursement as an option for transportation.  You will still need to schedule your trip with your health plan so that they know when you are going to see your doctor and how far you will have to go.

13.  Will transportation for grocery shopping be covered under KanCare?    
The plans will not be required to provide transportation for grocery shopping.  However, some of the plans may choose to provide this as a value-added service.  You should check your enrollment packet this fall to see which plans are covering additional transportation.

14.  What transportation is available for a client located in a small town 40 miles from his specialist?                                        
If you need to see a specialist in another town, you can get a ride from your KanCare health plan.  In some cases the plan may require you to go to the closest provider that can meet your medical needs.  Transportation can mean that the plan will send a car or van to pick you up. It could also means that the plan would give you gas money for you to drive yourself or have a friend/family member drive you.

15.  Will KanCare cover transportation services like MTM for out of state appointments?     
If the patient has an established care provider out of state, we will likely want to have that care continue. We understand that for certain areas of Kansas, out of state providers are the closest option for certain types of care.  If you need to see an out of state provider, you might have to get a referral from your health plan. 

16.  Will we replace MTM (Medicaid transportation management) with our MCO?  
Transportation will be the responsibility of the health plans after January 1 for all of their enrolled members. Each of the health plans is using a transportation broker, which is a company that will help the plans set transportation for their consumers.  The State will no longer have an agreement with MTM to provide this service, but one of the health plans might use MTM.

17.  Will the KEMT provider change?              
This person may mean NEMT - nonemergency medical transportation.  Each MCO will have it's own subcontractor for NEMT.

18.  MTM currently does not pay for transportation for children without a parent, is that changing?
The decision to transport a child alone or require parental supervision will be up to each of the MCOs.

Value Added Services

1.  For Medicare and Medicaid clients will there be benefits similar to regular private Medicare supplements such as Silver Slippers?               
We did find an exercise program for adults named Silver Sneakers.   KanCare will not cover this program unless it is a value added service by your KanCare plan.

2.  How can you get a healthy living plan?           
The KanCare health plans will offer wellness rewards programs to their members as a value-added service.  You should contact your health plan after you are enrolled for more information.

3.  Are there limits on what can be purchased with the prepaid incentive card, ie., alcohol/tobacco?                                        
The incentive cards are for things that help the health and wellness of the member. 

4.  Are there programs to quit smoking to improve health?             
Yes.  And there may also be rewards for using these programs.

5.  What are the different extra items offered by each MCO?          
You can find this information several places.  It is on the KanCare website and the MCOs' websites.  It will also be in the member managed care enrollment packet.

6.  What are the extra value-added options?      
You can find this information several places.  It is on the KanCare website and the MCOs' websites.  It will also be in the member managed care enrollment packet.

7.  Will the incentive prepaid debit cards be counted as income used in determining the monthly spenddown/client obligation?                          
No

8.  Pet therapy? What is it? What do you need to get it?
Sunflower will offer a pet therapy program. Therapy dogs are typically family pets which were initially considered for 'service dog' certification but experienced a 'career change' (typically due to medical issues, such as cataracts). These dogs are trained to interact with all types of people in a variety of different situations and settings. Therapy dogs are used to lift the spirits of those in nursing homes, under hospice care, and in facilities or hospitals. The Sunflower State Integrated Care Teams will have access to a certified therapy dog and handler, and work with the facilities to coordinate flexible or structured visits. Members must reside in an assisted living or nursing facility, or be on a Home and Community Based Services waiver to qualify for this service. Pet Therapy visits will be authorized by the member's Sunflower State care manager as part of the member's care plan.

9.  Amerigroup offers 250 cell phone minutes. Can I buy more? How much? Can I choose my phone?
Amerigroup offers this value-added benefit through the SafeLink Phone Service Program. We will help eligible members get a free cell phone and up to 250 minutes of service each month through SafeLink. Eligible Amerigroup members will receive an additional 200 bonus lifetime minutes on this phone. Members will receive the phone model currently in stock and will be able to buy additional minutes at 10 cents per minute.

10.  I'm on SSI and want to get off, so I'm going to school. How do I go about getting the career development services?
If you enrolled with Amerigroup, you can call Member Services at 1-800-600-4441 to get more information about our career development services. If you would like to receive career development educational DVDs after you’re enrolled with Amerigroup, just ask, and we will mail you a career enhancement 4-pack. If you need clothes for an interview, we will also mail you a $20 Goodwill voucher. This voucher can be used at any Kansas Goodwill location to purchase a gently used suit, or business casual clothing.

11.  Does "free in-home pest control" include mice?
Yes

12.  What age limit on children at YMCA?
For United, the age limit is 18 for YMCA membership. Sunflower also works with local agencies, such as the Boys & Girls Clubs, to provide memberships fees for our members. Sunflower State is currently working with local agencies so that we may provide additional details to potential members.

13.  If you are also covered by Medicare, and get 1 cleaning and 2 dental x-rays, will you be able to get a 2nd cleaning under KanCare? One per year under each plan, or just 1 for both plans?
For Amerigroup: If you have a Medicare Advantage plan or other insurance that offers a dental cleaning benefit, you must exhaust that benefit first, and then Amerigroup will pay for up to 2 additional cleanings in a calendar year.

For United: If the member has preventative dental benefits covered under Medicare then the KanCare Medicaid preventive dental coverage would be incremental to any Medicare services.

Vision

1.  Are glasses and eye exams deductible?          
We assumed this question was related to an individual with a spenddown.  If that is correct, then the answer is yes.  Glasses and eye exams can be counted towards a spenddown.

2.  I have Medicaid and have already got glasses but with KanCare can I get new ones that I like and look good on me?      
The selection of frames that are covered will be up to the MCOs.  But there may be a value-added service that will cover different frames.  Check when you receive information this fall.

3.  Is vision included in benefits?                            
Yes.  The scope of services will remain the same, but some or all the plans may be providing some additional vision benefit

4.  Will KanCare cover cataract care follow-up services?     
Yes

5.  Will KanCare pay for glasses?                             
Yes, coverage for glasses will continue.

Working Healthy

1.  I am on Working Healthy program, will KanCare change anything for me?          
Yes.  You will be enrolled in a KanCare health plan and you will receive your services through this plan starting in January.  You can change to a different plan if you choose to.  You will get information this fall in the mail about how to change your plan.

2.  Are the MCO's going to be taking over the WORK program?
Yes, the MCOs will be responsible for the WORK services.

3.  I pay a premium of $59 to HP Kansas on the Working Healthy Program for our son; will I continue to pay that?
Yes – your son will still be eligible for Medicaid under Working Healthy, and he will still be required to pay a premium based on his income. His health services will be provided through the MCO that he selects.

4.  How does KanCare affect people already on the WORK program?
While the MCOs will manage the services, people on the WORK program will receive services in the same way that they do now.

5.  How will the WORK program be handled starting January 1st?
Very similar to the way it is handled now. People will still be assessed for services, receive a monthly allocation, develop an Individualized Budget, and receive assistance to self or agency-direct their services.

6.  What specific long-term care services are you going to provide for individuals on the Working Healthy Program who sign up with you as their MCO?
The same long term care services that we provide now. The program will still be called WORK. People will still be assessed to determine the need for assistance. And services will include personal assistance using a monthly allocation to pay for these, and assistive technology on a case-by-case basis based on medical need.

7.  Does the current Working Healthy Program under the current Medicaid program have anything to do with the changes to KanCare?
People enrolled in Working Healthy will choose an MCO and receive their health services through their MCO.