KanCare enrollees with mental illness report gaps in Medicaid managed care program

A recent study of Kansans with serious mental illness enrolled in KanCare, the state Medicaid managed care program, revealed many significant unmet needs and barriers to care.

While managed care organizations (MCOs) have the potential to improve outcomes for enrollees by helping them navigate health care systems and manage chronic conditions, fewer than one in five of the survey participants reported having worked with a care coordinator, according to Jean Hall, who led the study. Hall is a University of Kansas professor of health policy & management and director of the Institute for Health and Disability Policy Studies at the KU Life Span Institute.

“Care coordination is especially needed for a population with mental illness or multiple chronic conditions and often difficulty with processing information,” Hall said. Further, many of the participants who had worked with a care coordinator reported positive experiences, she said.

“To the extent that care coordinators can assist enrollees in navigating their coverage and utilizing and understanding benefits,” Hall said, “their expanded use could address some of the problems identified by survey participants.”

These problems included:

• Difficulty accessing consistent information about their coverage, which made it difficult to find doctors and get care
• Difficulty accessing specific needed medications due to coverage limitations or out-of-pocket costs, which sometimes resulted in people being unable to take needed medications
• Lack of coverage for dental services other than cleanings — many noted that medications cause them to have a dry mouth, which can lead to cavities and other oral health problems
• Problems with using Medicaid-funded, non-emergency medical transportation services, such as a requirement to schedule rides three days in advance, which led to missed medical appointments
• Difficulty obtaining medical equipment or devices such as CPAP machines or diabetic shoes, which could result in worsening medical problems in the long term
• Limited provider networks, especially for specialists — some reported being unable to see specialists recommended by their primary care providers
• Difficulty obtaining or maintaining eligibility for KanCare due to application backlogs, which can lead to coverage gaps and lack of care.

The particular challenges of this population, such as unstable living conditions, lack of access to the internet, and difficulty processing and understanding information, make individualized support by a qualified professional especially important in accessing appropriate care and other necessary services, Hall said.

However, in general, participants were happy to have KanCare coverage and thought that out-of-pocket costs were reasonable, the report found. They appreciated having prescription coverage and protection from catastrophic medical costs.  

“As the state begins the process to accept bids for new managed care contracts,” Hall said, “we hope that some of these findings can be used to strengthen the KanCare program not only for enrollees with mental illness, but for all Kansans.”

Hall is a national expert in health care policy and has published numerous scholarly articles in journals such as Inquiry, Annals of Internal Medicine, American Journal of Managed Care, Journal of Disability Policy Studies, Disability and Health Journal, Journal of Public Health Dentistry, Journal of Vocational Rehabilitation, American Journal of Public Health, and American Journal of Health Promotion. Moreover, her research has been cited in numerous national media including the New York Times, Time, the Washington Post, National Public Radio, ABC News, BusinessWeek and Health Affairs.

The study was supported by a grant from the Health Care Foundation of Greater Kansas City and co-authored by Noelle Kurth, senior assistant researcher, and Tracey LaPierre, associate professor of sociology at KU.