Overview of Medical Assistance Programs

Medical Assistance Programs

The State of Kansas offers medical assistance to eligible Kansans through three major programs.

Medicaid. Medicaid is part of KanCare, the state’s managed care program, and covers Kansans with limited income who meet program eligibility criteria in the following groups: pregnant women, children up to age 19, adult caretakers of children, persons who have aged out of foster care, individuals with disabilities, and senior citizens.

Children’s Health Insurance Plan (CHIP). CHIP is also part of KanCare and provides coverage to uninsured children up to age 19 who do not qualify for Medicaid.

MediKan. MediKan is a fully state-funded program that provides time-limited coverage to persons who are applying for Social Security disability benefits.

KanCare

KanCare is the State of Kansas’ managed care program and utilizes a variety of special programs to administer Medicaid. KanCare services are provided by contracted Managed Care Organizations (MCOs).

The first MCO contracts for KanCare began in January 2013 and ended December 31, 2018. The second set of MCO contracts, often referred to as KanCare 2.0, began January 1, 2019, and will end December 31, 2024. The State entered its third contract with MCOs (KanCare 3.0) in 2024. These contracts will begin January 1, 2025.

Eligibility

All persons who receive KanCare must reside in Kansas and either be a U.S. citizen or a non-citizen who meets a qualifying status as determined by the U.S. Department of Homeland Security. Individuals must also meet medical, age, and financial eligibility requirements. KanCare eligibility is determined on an annual basis.

Providers

The MCOs under KanCare 2.0 are Sunflower Health Plan (Sunflower), UnitedHealthcare Community Plan of Kansas (UHC), and Aetna Better Health of Kansas (Aetna).
Beginning January 1, 2025, the MCOs for KanCare 3.0 will be two incumbents, Sunflower and UHC, and a new MCO, Healthy Blue (Community Care Health Plan of Kansas and Healthy Blue).

KanCare 3.0 Procurement Process

The request for proposal (RFP) was written over many months through a joint agency effort that included the Kansas Department of Administration (DOA), Kansas Department of Health and Environment (KDHE), and Kansas Department for Aging and Disability Services (KDADS). The KanCare 3.0 RFP was released by DOA in October 2023, and a contract was announced in May 2024. The minimum contract term will be January 1, 2025, to December 30, 2027, with an option for the State to renew for two one-year terms. If the option to renew is authorized, the contracts could extend through December 30, 2029, at the latest.

Payment

KDHE pays each MCO a set per-member, per-month rate as specified in their contracts. This capitated rate is calculated each month and is based on the number of individuals enrolled in each eligibility category that month and the anticipated services they will require, including pharmaceuticals.

When establishing the rates at which MCOs are paid, KDHE must comply with federal regulations requiring such rates be developed in accordance with accepted actuarial practices and certified by qualified actuaries. Rates must be high enough to attract a provider base that can meet contractual requirements for availability and accessibility of services. KDHE’s actuaries review the MCO rates on a regular basis and adjust rates as needed to ensure they remain actuarially sound.

Agency responsibilities

KDHE

The State Medicaid Director is housed within KDHE, the primary agency involved in the management of KanCare. KDHE is responsible for MCO contract oversight, claims management, and ensuring that KanCare 3.0 meets all standards as required by the federal government. The federal partner for KanCare is the Center for Medicare and Medicaid Services (CMS). CMS is the federal agency that provides health coverage to more than 160 million individuals through Medicare, Medicaid, CHIP, and the Health Insurance Marketplace.

KDADS

A specialized component of KanCare is the Home and Community Based Services (HCBS) waivers, a system of community-based supports and services for persons in Kansas with disabilities, administered by KDADS. The HCBS provider network includes a variety of not-for-profit and for-profit organizations, as well as governmental entities. These services are provided through seven HCBS waiver programs.

KanCare 3.0 Improvements

KDHE and KDADS have jointly announced several key improvements included in the KanCare 3.0 MCO contracts, including:

• Educating, engaging, incentivizing, and empowering members to achieve personally defined health goals;
• Enhancing care coordination to ensure timely access to needed services, continuity of care, successful care transitions, and improved member outcomes;
• Improving prenatal and postpartum care, including requirements for maternity care coordination;
• Increasing the recruitment and retention of providers; and
• Expanding access to services in rural and frontier areas.

Open Enrollment

Members of KanCare will have two open enrollment periods in 2024 and 2025. As there is a new MCO, a minimum 60-day open enrollment period will be held in 2024. In addition, the regularly scheduled 90-day open enrollment period will occur between January 1, 2025, and March 31, 2025.