WICHITA EAGLE: Kansas lawmakers cut welfare benefits, approve Medicaid drug step therapy

By Dion Lefler
May 1, 2016

In its next-to-last act of 2016, the state Legislature passed a bill cutting welfare benefits and requiring low-income Medicaid patients to try cheaper treatments before more expensive drugs could be prescribed.

The bill

SB 402

The votes

79-43 in the House, 27-13 in the Senate

How SB 402 changes welfare

The bill contains several provisions to cut Temporary Aid to Needy Families, including:

▪ Reducing lifetime limit on receiving TANF benefits from 36 months to 24 months. If any adult in a household has met that limit, no one in the household would be eligible.

▪ People who had previously received a TANF diversion payment would be limited to 18 months of lifetime eligibility for TANF payments.

▪ Removing $25 limit on welfare ATM withdrawals, which federal officials said was illegal and threatened Kansas’ access to federal funding.

▪ Revoking eligibility if any recipient in a household fails to participate in work or job training required by the Department of Children and Families.

An exemption in the work requirement for parents with a child under 3 months of age would not apply if an adult in the household has received TANF assistance for more than 24 months.

Arguments for

▪ The changes will save millions of dollars for the state.

▪ Reduced welfare eligibility forces able-bodied adults to go to work, the most effective way to lift families out of poverty.

▪ The changes will prevent people who are living together from gaming the system by having different adults apply for benefits when one has exhausted his or her eligibility.

▪ Approximately 80 percent of voters support work requirements for welfare recipients.

Arguments against

▪ The bill penalizes multi-generation families where a parent or grandparent has exhausted TANF eligibility.

▪ Women with newborn babies could be forced to go back to work too soon after giving birth if a family member has exhausted his or her TANF eligibility.

What they said

“Anybody who tells you government assistance is better than a job is lying.”

– Sen. Michael O’Donnell, R-Wichita

“We are making it harder for the most vulnerable, for the working poor. We, the state of Kansas, need to do a better job of creating businesses that create jobs that pay a living wage and benefits.”

– Sen Oletha Faust-Goudeau, D-Wichita

How SB 402 changes Medicaid health care for the poor

Low-income patients would generally be required to undergo so-called “step” therapy when they have an illness or condition requiring drug treatment.

In essence, that means their doctor would have to prescribe the least expensive drug first and only step up to a more expensive drug if the patient failed to respond to the cheaper treatment.

The physician could appeal to the patient’s KanCare managed-care provider to use a more expensive treatment under the following conditions:

▪ The required drug is likely to cause physical or mental harm to the patient.

▪ The required drug is expected to be ineffective because of the patient’s clinical history.

▪ The patient has already tried the required drug and it didn’t work.

▪ The patient has proven to be stabilized on a treatment other than the required drug.

Arguments for

▪ Requiring lower-cost medication is expected to save about $10.5 million, which will flow to the state General Fund. The private managed care organizations that provide Medicaid services in Kansas under contract to the state also benefit, because by saving costs on their operations, they avoid cuts in the rates the state pays them.

▪ Doctors who appeal to use a more expensive treatment for a patient would be guaranteed a decision by the managed care organization within 72 hours.

Arguments against

▪ The bill interferes in the doctor-patient relationship, allowing the managed-care insurance company to substitute its judgment for the physician’s on what drugs will work on a given patient.

▪ Patients could have to suffer trying ineffective drugs before getting stepped up.

▪ Low-income, elderly and disabled people could have a hard time negotiating the appeal process.

▪ Free samples of drugs, often given by doctors to their poorest patients, don’t count in making the decision of whether a drug has already been tried and found ineffective.

What they said

“I am proud to say that the House, through all of your work and our conference committee’s work, has produced six different patient protections for this bill.”

– Rep. Dan Hawkins, R-Wichita

I think that is a very poor choice and once again a way of people meddling in medical practice rather than letting the doctors do what is best for the patient.

– Rep. Barbara Bollier, R-Mission Hills

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