State Selects Companies to Manage KanCare
Earlier this year, the Kansas Department of Health and Environment (KDHE) announced the selection of and contract awarding for the next three managed care companies (MCOs) for the KanCare program.
Two include current companies (Sunflower Health Plan and United Healthcare Community Plan), and one is new to the state plan (Healthy Blue). As nearly 61 percent of KanCare enrollees are children and another 14 percent are parents or caretakers of children, this decision will significantly impact families’ health care access over the next few years. The new contracts provide an opportunity for better services for families and greater accountability for how the companies are serving their members.
KanCare is Kansas’ managed care delivery system for Medicaid and CHIP coverage for low-income families, the disabled, and the elderly. Last fall, we provided a brief overview of managed care and described the most recent contract selection process.
In early October 2024, KDHE moved forward with the open enrollment period ahead of the new contracts’ implementation on January 1, 2025, including the transition from Aetna Better Health of Kansas (which was not selected for the new contract) to Healthy Blue, the MCO that will take Aetna’s place. Part of this process included public meetings around the state and online in mid- to late-October where information about the changes were shared with interested KanCare members and providers.
Special Enrollment Period
Based on information shared by the state, here are the important details for families and advocates to be aware of. From October 1 through December 17, 2024, current KanCare members can change their MCO through a special open enrollment period for when the new contracts go live on January 1, 2025. Enrollees will also have an additional special period between January 1, 2025, and April 4, 2025, to request a change of MCO.
Depending on a member’s current company, the steps described below may be a little different. Regardless, each MCO provides different Value-Added Benefits (extra benefits) and may have a different provider network.
- Sunflower Health Plan
- United Healthcare Community Plan
- Healthy Blue Kansas
- Value-Added Benefits
- Member services can be reached at 833-838-2593 to search for providers (provider search is not online yet, as of late October 2024)
Current Aetna Members
Members currently enrolled with Aetna should have received communications (mail, email, and/or text) from the state indicating that Aetna Better Health of Kansas will be replaced by Healthy Blue as of January 1, 2025. If no action is taken, members will be automatically enrolled in the Healthy Blue plan and receive a new member ID card from the new health plan.
To not be automatically assigned to Healthy Blue, enrollees must take one of the following steps:
- Mail the completed Annual Open Enrollment form before the Open Enrollment period ends on December 17, 2024, allowing at least three days for mail time. A letter will be sent once changes have been made;
- Make changes online through the KanCare member portal; or
- Call the Enrollment Center at 1-866-305-5147.
Current Sunflower and United Members
Members should have received communications from the state indicating an opportunity to change their current MCO this fall, including switching to the new company, Healthy Blue. If no action is taken, members will keep their current MCO.
If members want to change from their current MCO, they must either:
- Mail the completed Annual Open Enrollment form before the Open Enrollment period ends on December 17, 2024, allowing at least three days for mail time. A letter will be sent once changes have been made;
- Make changes online through the KanCare member portal; or
- Call the Enrollment Center at 1-866-305-5147.
Important Dates
- October 2024 – Enrollment packets mailed to current members.
- October 1, 2024 – First date to make an MCO plan choice
- December 17, 2024 – Last day to make an MCO choice for the January 1, 2025, effective date
- January 1, 2025 – New contracts go live
- April 4, 2025 – Last day of the extended date to choose a different MCO
What Will Change?
The state indicated several goals with the new contracts, including:
- Improving health outcomes by providing integrated care that recognizes the impact of social determinants of health (including food access, housing, and transportation);
- Reducing health care disparities;
- Expanding the provider network; and
- Leveraging data to promote continuous quality improvement for the entire program.
Hundreds of new requirements and accountability measures are present in the new contracts, including non-emergency medical transportation, a future centralized credentialing system for providers, and the identification and addressing of health disparities.
The new contracts are particularly focused on improving maternal and infant health through maternity care coordination, offering additional value-added benefits to pregnant and postpartum women, and making available a dashboard reporting on prenatal and postpartum measures, revealing how MCOs are performing as they work with this population.
All members will go through health screenings and identification of social determinants of health (SDOH) needs. The companies will be tasked with developing services to support and address these identified needs, as well as tracking member referrals to SDOH services.
Food access, housing situations and conditions, transportation, and numerous other health-related life circumstances directly impact a family’s health, and we look forward to seeing the impact of the new contracts’ intense focus on maternal and infant health and SDOH.
Conclusion
KanCare is an important program that provides health care access and impacts the health outcomes of more than 440,000 Kansans, particularly children. The selection of Sunflower Health Plan, United Healthcare Community Plan, and Healthy Blue to run the program will play an integral role in getting those Kansans efficient, timely, and high-quality care so they can lead healthy lives. We’re optimistic the new expectations, enforcement, and required services of these companies will result in a program that better serves the needs of KanCare recipients and the providers that care for them.
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