Kansas: Single Payer Program

Kansas: Single Payer Program

Upshot

  • H.B. 2459 would create the Kansas Health Program, a universal single-payer guaranteed health coverage program for all residents of the state, regardless of immigration status.

  • The program would provide coverage for existing benefits included in Medicare, Medicaid, CHIP, and the individual Marketplace plan. Beneficiaries would also be required to enroll with a care coordinator to ensure that beneficiaries are receiving high-value and appropriate care.

  • In the Republican controlled legislature, the legislation largely served as a messaging bill towards the need for more affordable health coverage in the state. The bill ultimately died in Committee

Background

Kansas uses the federally-facilitated individual Marketplace, Healthcare.gov. Seven insurers offered plans in 2022, which was a record high for the state. Approximately 107,000  residents enrolled for Marketplace coverage during the 2022 open enrollment period.

Kansas is one the twelve states that has yet to expand Medicaid eligibility to the ACA level of 138 percent FPL. An additional 145,000 residents would become eligible for coverage if Kansas expanded Medicaid. Gov. Laura Kelly included Medicaid expansion proposals in her fiscal years 2022 and 2023 budget requests, but the expansion was not included in the budgets approved by the Republican-controlled state legislature. Additionally, the legislature has failed expand Medicaid in standalone legislation three times.

Summary

The bill, H.B. 2459, would establish the Kansas Health Program to provide all residents access to health care coverage at no cost. Enrollees would have access to the EHBs and would be required to enroll with a care coordinator to ensure appropriateness of services received. Additional details of the program follow.

  • Kansas Health Advisory Council and Board of Trustees: The bill would establish a Kansas Health Advisory Council that would be responsible for developing and implementing the Kansas Health Program and would advise the Secretary of Health on matters related to the program. Additionally, the bill calls for the establishment of the Kansas Board of Trustees, which would review, provide feedback, and approve any proposed rules and regulations issued by the Secretary to implement the Kansas Health Program.

  • Eligibility and Enrollment and Beneficiary Cost Sharing: Every state resident, regardless of immigration status, would be eligible and entitled to enroll in the program and would not be required to pay a premium, copayment, coinsurance, deductible, or any other form of cost sharing for all covered benefits. To control program costs, enrollees would also be required to enroll with a care coordinator to ensure that beneficiaries are receiving high-value and appropriate care.

  • Benefits: Covered health care benefits for enrollees would include all healthcare services that are required to be covered by the following programs, regardless of eligibility for such programs:

    • CHIP

    • Medicaid, including services provided under Medicaid waiver programs;

    • Medicare;

    • Services required under Kansas’ Insurance Statute (i.e., the EHBs); and

    • Any additional health care service authorized to be added to the program’s benefits.

    Existing health insurers would be permitted to cover any services that are not covered by the program but would be prohibited from offering coverage of program benefits. Additionally, the program would be prohibited from requiring prior authorization for any health care services that is more restrictive than what is required under Medicare Parts A and B.

  • Payment for Health Care Items and Services: The Secretary would be directed to adopt rules and regulations for payment methodologies for healthcare services and care coordination. Additionally, the methodologies and rates would be required to be “reasonable and reasonably related” to the cost of efficiently providing the healthcare service and assuring adequate and accessible supply of the service.  The Secretary would be required to consider the following factors when determining the payment methodologies: 1) usual customary rates immediately prior to the implementation of the program, as reported by the Commissioner of Insurance; 2) level of training, education, and experience of the providers; and 3) scope of services, complexity, and circumstances of care, including geographic factors. The Secretary and health care provider representatives would be required to engage in good faith negotiations to determine payment rates.

  • Waivers and Funding: The Secretary would be required to seek all federal waivers, such as section 1332 and section 1115, state plan amendments, and other federal approvals necessary to operate the program. Pass-through funding secured through the waivers would be used to implement the program.

    Additionally, the governor would be directed to submit to the legislature a revenue proposal, as part of the governor’s budget for fiscal year 2024, that includes a progressively graduated tax on all payroll and self-employed income to finance the program. Individuals with income less than $25,000 a year would be exempt from the increase in taxes. This tax revenue would be deposited in the Kansas Health Trust Fund for program implementation. The revenue plan would need to be approved prior to the implementation of the program.