Volume 4, Number 4

April, 2005

 

Work Opportunities Reward Kansans (WORK)

By Mary Ellen O'Brien Wright, Working Healthy Program Director

Working Healthy and other Social and Rehabilitation Services (SRS) staff and partners are continuing efforts to implement personal assistance services for people enrolled in Working Healthy. In August 2004, an 1115 Independence Plus demonstration application, titled WORK Opportunities Reward Kansans (WORK), was submitted to the Centers for Medicare and Medicaid Services (CMS). SRS has twice been asked to respond to “Requests for Additional Information” (RAI). SRS responded in writing to the first RAI, which consisted of 87 questions, in December 2004. The written response to the second RAI was sent in March 2005. 

Negotiations with CMS have focused on program clarification, the ability of SRS to maintain required budget neutrality for WORK, the income and asset limits for WORK enrollees, and the services to be offered through the new waiver. In addition to responding to the questions in writing, negotiations have involved several conference calls with CMS Central and Regional office staff, as well as representatives from other Federal agencies, including the General Accounting Office (GAO). SRS anticipates that CMS will request a third conference call in the early spring. 

If approved, WORK will provide personal assistance services for Working Healthy enrollees who require these services to live and work in their communities. WORK will employ a “cash and counseling” model, allowing enrollees to directly handle the money for their services, as well as the flexibility to choose alternative methods for obtaining such services. 

Medicaid/Title XIX is one of several programs in the broader Kansas Medical Assistance Program (KMAP). KMAP also includes Medi-Kan, HealthWave and KAN-Be-Healthy. The following information is provided for consumers or providers who want to know more about these various medical programs available to Kansans.

An Unasked Question

By Kirk Maher, Liaison, Kansas Medical Assistance Progarm

I’m sure we have all heard “that the only stupid question is the one that goes unasked.” This is especially true when it comes to your health insurance coverage. Understanding how our health insurance works is not only important, but essential to fully participate in health care decisions. However, some people are afraid to ask questions about their medical coverage...in case it’s a “stupid” question.

The Kansas Medical Assistance Program (KMAP) wants beneficiaries to feel comfortable seeking assistance getting answers to their questions, and encourages them to contact KMAP resources whenever they have questions or concerns about their health benefits. KMAP believes that the better educated beneficiaries are, the better consumers they will be when seeking services.

KMAP wants beneficiaries to have a good understanding not only of their rights when it comes to their medical coverage, but also their responsibilities. To assist our beneficiaries in understanding their health benefits, the program has provided a number of resources to help answer their questions. Some of these resources are:



• The Kansas Medical Assistance Program Medical Benefit Booklets. These printed booklets are mailed to all KMAP beneficiaries yearly as a guide to their health benefits, rights and responsibilities, types of coverage and other helpful information. Booklets are also available upon request at the local SRS offices. In the future, Newly eligible beneficiaries will be mailed this booklet upon becoming eligible.



• The KMAP Website. The KMAP website provides information on health coverage and medical policy for beneficiaries and providers. The KMAP website consists of three main sections, Beneficiary, Provider and KAN Be Healthy. It is written to meet the needs of those specific groups. 

o The Beneficiary section allows access to information useful to beneficiaries. This includes access to an on-line version of the benefit booklet mentioned earlier, a provider directory search window where lists of KMAP providers can be accessed, copies of beneficiary notices, a link to the FirstGuard website and information on appeal rights.



o The Provider section of this website is divided into secured and non-secured sides. The non- secured side provides access to provider manuals and bulletins, plus a variety of other provider- focused information. The secured side of this section is password protected and restricted for provider use only.



o The KAN-Be-Healthy section provides information geared to beneficiaries who are under the age of 21, participating in the KAN-Be-Healthy Program.• Medical Assistance Customer Service Center (MACSC). The MACSC phone line at 800-766-9012 is open from 7:30 am to 5:30 pm, Monday through Friday and is dedicated to answering questions about medical benefits and assisting to resolve issues related to KMAP.

• KMAP Liaisons. Twelve Liaisons are strategically placed in the five designated SRS Management Regions across the state by EDS, the Fiscal Agent for the KMAP. The Liaisons serve as both resources on KMAP issues/questions and as facilitators for communication among EDS, Health Care Policy/Medical Policy, the Regional SRS Offices, providers and beneficiaries. KMAP Liaisons also provide support and training to local SRS staff and outreach education to the communities they serve. 

Benefits Specialists' Corner

This issue features Working Healthy Benefits Specialist Judi Vargas from the Manhattan SRS Office. When not at work, Judi like to learn new things and take classes. She is currently finishing up her first year of graduate school with one year left. During school breaks she tries to find time to travel to places she has never been before, especially where there are beaches! Judi enjoys cooking, working out, encouraging other people to exercise, dancing, and listening to all kinds of music. On the flip side; she also likes to follow politics, world events and business. Judi can be contacted by phone at 785-776-4011 ext. 227 or by E-mail at MJXV@srskansas.org. 

"Over the past two and a half years, I have seen many positive changes with the Working Healthy program. With the knowledge consumers have gained regarding various work incentive programs, many more people are confident about going to work. Not only do they hear about the positive outcomes, they see them. Some outcomes that consumers have seen or experienced are: accumulation of assets, staying employed longer, better health, increased self-esteem, increased job skills and financial stability. Work incentive programs, including Working Healthy, have made this possible for so many Kansans. 

With so many programs available to consumers, part of our job as Benefits Specialists is to inform all affected consumers of the resources they can access. As times change, new information regarding programs can also change. However, asking questions and accessing community resources will help individuals stay informed of all the benefits available to them. As Benefit Specialists we, too, do all of these things to stay informed. 

We are also helping individuals who do not qualify for Social Security Administration (SSA) benefits because of resources or income. Individuals who can work part-time may still be able to qualify for Working Healthy coverage even if they get turned down by SSA because of income and/or resources. The “medically improved” category has also allowed individuals to continue Medicaid coverage through Working Healthy, when they would otherwise not qualify for any Medicaid benefits. These components of our program make Working Healthy unique, because we offer Medicaid coverage that wouldn’t otherwise be available to working Kansans with disabilities. It has been exciting to see how positive changes to our program have helped individuals in these situations and how continued expansion of our program has the potential to help many more."



-Judi Vargas, Working Healthy Benefits Specialist







Working Healthy is published quarterly by the University of Kansas CRL, Division of Adult Studies and in cooperation with the Kansas Department of Social and Rehabilitation Services. Additional copies and copies in alternate formats are available upon request by writing the University of Kansas Division of Adult Studies, Attn: Noelle, 1122 West Campus Rd.. JRP Hall Rm. 517, Lawrence, KS 66045, by phone 785-864-7085, by email: pixie@ku.edu

KU Research Team:

Jean Hall, Principal Investigator

Noelle Kurth, Project Coordinator and Editor

Dan Cox, Graduate Research Assistant

SRS, Division of Health Care Policy:

Mary Ellen O'Brien Wright, Program Director

Nancy Scott, Benefits Specialist Team Leader