By CELIA LLOPIS-JEPSEN

The Trump administration has nixed Kansas’ idea of a three-year lifetime cap on Medicaid benefits.

Gov. Jeff Colyer had wanted to include the limit in a remake of the state’s privatized Medicaid system, KanCare. He also wants work requirements for non-disabled KanCare beneficiaries.

Late last month, he walked back his stance on pursuing a lifetime cap, while sticking by the work proposal. Both ideas had faced criticism from health care advocates who fear they would reduce poor people’s access to doctors and medication.

In a press release Monday, Colyer said the call to back off from a three-year limit came after conversations with the federal agency in charge of that program made clear the Trump administration wouldn’t allow it.

But the federal government does support work requirements for Medicaid, which Colyer highlighted as a win.

“We are pleased,” he said. “This important provision will help improve outcomes and ensure that Kansans are empowered to achieve self-sufficiency.”

The top administrator at the Centers for Medicare and Medicaid Services revealed the agency’s decision against a three-year Medicaid limit in a talk Monday to hospital administrators and in a letter to Kansas officials the same day.

That agency has granted requests from other states for certain eligibility limits on Medicaid, including work requirements.

“In every case,” the CMS wrote to Kansas health officials, “these incentive structures are designed to engage beneficiaries in ways that promote positive health and well-being.”

The advocacy group Alliance for a Healthy Kansas, which promotes expanding Medicaid coverage to around 150,000 more people in the state, applauded the federal agency’s Monday announcement in a statement that called the three-year cap “the most harmful” part of Colyer’s vision for KanCare.

It’s an “arbitrary bureaucratic time limit,” the group wrote and would risk interrupting someone’s insurance, including “in the middle of a critical course of treatment.”

Colyer, a physician and a chief architect of privatizing Medicaid in Kansas, ultimately needs to win over not just the federal government but also the Legislature to move ahead with work requirements. That’s because lawmakers passed a budget this month that blocks Colyer from doing so without their permission.

Celia Llopis-Jepsen is a reporter for the Kansas News Service. You can reach her on Twitter @Celia_LJ.

TOPEKA, Kan. (AP) — Several doctors at Larned and Osawatomie state hospitals and Kansas state prisons are working with special “institutional licenses” despite not having a full medical license, in part because the state has a severe shortage of psychiatrists, state officials said.

Nine of the 13 physicians at Larned and 10 of the 22 physicians at Osawatomie are currently on “institutional licenses,” according to Kansas Department for Aging and Disability Services. And at the state’s prisons, one of nine medical doctors and four of nine doctors who specialize in psychiatric medicine have the limited licenses, according to Corizon Health, the state’s corrections health care contractor, The Kansas City Star reported .

The practice is not new and it is necessary because the state doesn’t have enough psychiatrists, said Tim Keck, secretary of the aging and disability services.

“The agency appreciates our institutionally licensed doctors,” Keck said in an emailed statement. “They are dedicated and they work hard every day to provide good care to our patients.”

But Rick Cagan, executive director of the National Alliance on Mental Illness’ Kansas branch, said allowing institutional licenses at state facilities means Kansans who need the most help often are cared for by doctors who, at least on paper, are less qualified.

“I am concerned that the most acutely ill individuals are receiving treatment from physicians who do not meet the highest standards for practice,” Cagan said. “It’s counter-intuitive that those most seriously ill have access to physicians who are denied the ability to establish a community-based practice.”

Although the practice has occurred in Kansas and elsewhere for decades, Republican state Sen. Barbara Bollier, a retired physician from Mission Hills, said it might be time to discuss whether the practice should change.

“Why are we still doing this?” Bollier said. “That’s the biggest question. I don’t have an answer. … If that is good enough for (state hospitals), why aren’t these same things in place for the entire population of the state? Why do we have different standards?”

None of the doctors practicing on institutional licenses has been sanctioned for violating standards of care, according to Kathleen Lippert, the executive director of the Kansas Board of Healing Arts.

Kansas and about 20 other states offer limited licenses to allow doctors who aren’t able to start a private practice to work in state mental institutions. After three years with institutional licenses, doctors also can practice at other public facilities like community mental health centers.

Kansas established the institutional medical license in 1969, when the nation began shifting away from long-term institutionalization for the mentally ill to community-based care. Larned and Osawatomie are the last state hospitals in Kansas and have about 300 beds between them.

Missouri, which employed a national-high 47 limited license physicians in its mental health program in 1990, has phased out the program.

Debra Walker, spokeswoman for the Missouri Department of Mental Health, said its seven state mental institutions recruit psychiatrists by working closely with medical school residency and fellowship programs. The department also allows flexible work schedules so its psychiatrists can work outside the state system for additional income.

Walker said the department currently employs 34 psychiatrists and has 6.5 openings, a vacancy rate of about 16 percent.

TOPEKA, Kan. (AP) — Persistent budget problems that followed a now-abandoned tax-slashing experiment in Kansas helped kill new cuts this year that were meant to return an unexpected “windfall” to the state from changes in federal tax laws.
Top Republicans pushed Friday — the last day of the GOP-controlled Legislature’s annual session — for passage of a bill that would save taxpayers an estimated $78 million during the state’s next budget year, which begins July 1. It was a response to changes in federal tax laws that will force some individuals and corporations to pay more to the state because the state’s tax code is tied to the federal one.
The Senate passed the bill, 21-19 , early Friday morning, but it failed on a 59-59 vote Friday evening in the House after Republican leaders spent hours trying to cajole reluctant lawmakers to support it. A frustrated Senate adjourned for the year as the House held its vote open in hopes that missing members would return or some no voters would switch to yes.
Top Republicans had on their side business groups and the compelling political argument that the state shouldn’t collect extra dollars from its taxpayers that it hadn’t expected anyway. But legislators had earlier increased spending on public schools to satisfy a court mandate and added spending in other areas of the budget that they felt they had neglected for years.
Over the debate hung the shadow of the income tax cuts former Republican Gov. Sam Brownback engineered in 2012 and 2013, which were followed by budget woes that prompted lawmakers to reverse most of them last year to stabilize the state’s finances. Republicans split on this year’s tax-cutting bill, and critics repeatedly cited the experiment that made Kansas a national example of how not to do trickle-down economics.
“It’s Brownback all over again,” said state Rep. Tom Sawyer, of Wichita, the top Democrat on the House Taxation Committee. “We just got over that nightmare, and people did not want to relive it again.”
Republicans who supported the tax bill said it was unfair to characterize it as a return to the policies of Brownback, who stepped down as governor in January for an ambassador’s post. The proposed cuts were far smaller and, GOP lawmakers said, designed to keep people from paying taxes even higher than lawmakers intended when they approved a $600 million-a-year income tax increase last year.
One major change would have allowed Kansas filers to itemize on their state returns even if they do not on their federal returns, something they cannot do now. The federal changes limited some deductions and raised the federal standard deduction, so fewer Kansas would itemize.
“We have to do something, or this money is stolen from the taxpayers,” conservative GOP Rep. John Whitmer, of Wichita, told colleagues during a meeting of fellow House Republicans meant to build support for the bill. “It’s their money. Let’s give it back to them.”
Other Republicans argued that the real problem was a failure to control spending.
Lawmakers in April approved a new education funding law that will phase in a $534 million increase in spending on public schools over five years to comply with a Kansas Supreme Court ruling in October. The court said the state’s current funding of more than $4 billion a year isn’t sufficient under the state constitution, and it will review the new law in a May 22 hearing.
Legislators also added millions of new dollars elsewhere, restoring some past cuts in higher education, granting pay raises to state workers and attempting to catch up on past shortings of the state’s annual contributions to public pensions.
Some Republicans were quick to note that even without factoring any tax cuts, projections from the Legislature’s research staff suggested that the state could be facing budget shortfalls again within a few years.
“With or without this bill, the spending is in the red,” Senate tax committee Chairwoman Caryn Tyson, a conservative Parker Republican, told her colleagues during a debate on the tax legislation. “It has nothing to do with this bill.”
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TOPEKA, Kan. (AP) — The Latest on the Kansas Legislature’s debate on tax cuts and budget issues (all times local):

5:28 p.m.

Kansas legislators have narrowly rejected a bill cutting income taxes because some lawmakers worried that it would create future budget problems.

The vote Friday in the House was 59-59 on a bill that would save taxpayers an estimated $78 million during the state’s next budget year that begins in July.

The measure was a response to changes in federal tax laws last year that would force some individuals and corporations to pay more to the state. Many Republicans argued that the state should return the unanticipated “windfall.”

But GOP legislators were split. Critics argued that the bill could lead to budget shortfalls as early as next year.

Legislators earlier increased public school funding to meet a court mandate and added money to other parts of the budget.

___

3:48 p.m.

Top Republicans are struggling to push a bill cutting income taxes through the Kansas Legislature because some lawmakers worry that it would create future budget problems.

GOP leaders hoped the House would vote Friday on a bill that would save taxpayers an estimated $78 million during the fiscal year beginning in July.

The measure is a response to changes in federal tax laws last year that would force some individuals and corporations to pay more to the state.

The Senate approved the bill early Friday, 21-19.

Republicans are split and Democrats oppose the measure. Critics argue that it would create budget shortfalls as early as next year.

Legislators also have increased spending on public schools to meet a court mandate and added money to other parts of the budget.

By MADELINE FOX

The Kansas Legislature has narrowly approved a controversial measure allowing faith-based adoption and foster care agencies in Kansas to be reimbursed by the state for placement services, even if they turn away prospective parents who don’t fit their religious beliefs.

The bill that includes the provisions constituting the “Adoption Protection Act” passed the House shortly before midnight Thursday with the bare minimum 63 votes in favor with 58 against. The Senate followed suit a couple hours later on a 24-15 vote. In a statement Gov. Jeff Colyer said he would sign it.

Opponents argued the religious protections would open the door to state-sponsored discrimination, particularly against same-sex couples, but also single people and minorities.

“Christian slaveholders used the Bible and their strongly or sincerely held religious beliefs to justify slavery.” said Rep. Barbara Ballard, a Democrat from Lawrence.

Proponents contend the measure will keep more adoption agencies in Kansas at a time when more than 7,000 children are awaiting permanent homes. Department For Children And Families Secretary Gina Meier-Hummel endorsed the measure.

“Some might allege this bill would perpetuate discrimination, and nothing could be further from the truth,” said Rep. Susan Humphries, the Wichita Republican who sponsored the measure. “This bill simply ensures that all providers can stay in the field and continue to serve children, unafraid of government censorship”.

Humphries described the religious protections as “preemptive”, enabling faith-based placement agencies to weather lawsuits and withstand changes in state leadership.

The Oklahoma Legislature passed similar legislation hours before Kansas lawmakers took their votes Thursday.

Catholic Charities, which operates in Kansas, testified in support of the measure. The organization stopped offering adoption services in Massachusetts to avoid having to facilitate adoptions by same-sex couples there.

The Family Policy Alliance also lobbied for the Kansas bill, and it won a last-minute endorsement from Kansans For Life, the leading anti-abortion group in the state.

“Passage of the Adoption Protection Act means that more, rather than fewer, groups, will be able to assist in facilitating adoption, and that will result in fewer babies being aborted,” Mary Kay Culp, executive director of Kansans for Life said in a released statement.

The Human Rights Campaign, a national gay rights group, showed up at the statehouse last week to speak against the religious exemption, and took out full-page ads in state newspapers reading, “Keep Kansas Open To All.” TechNet, a network of large technology companies including Apple and Google, sent a letter to lawmakers expressing opposition to the bill.

The Northeast Johnson County Chamber of Commerce also voiced its opposition to the bill.

“If we become a state that is shown to discriminate, how easy is it going to be for us to go out and recruit new talent, and retain them once we get them here ?” said NEJC president Deb Settle. “If they’re originally from Kansas, how are we going to keep them here, if we’re a state that’s showing discrimination?”

The debate threatened to torpedo long-needed updates to Kansas adoption law contained in the underlying bill – updates including a change to say “married couples” can adopt, rather than “husband and wife.” Earlier this session, the House rejected the original version of the religious protection measure, subsequently added to the adoption bill as an amendment.

The bill squeaked through with a compromise clarifying that the religious exemptions would only apply to foster care and adoption services, and not anything else that a faith-based agency might provide, like health care or housing.

For Rep. John Carmichael, the House Judiciary Committee’s ranking Democrat, the refined language didn’t make the bill any more defensible.

“If you allow people to use state dollars in accordance with their sincerely held religious beliefs, for the purpose of discriminating against another religion … based on sincerely held religious beliefs, that shreds the purpose of the first amendment,” Carmichael said. “I cannot countenance that.”

At present, and under the bill, child placement agencies that refuse to place children with same-sex couples, single parents, or non-Christians, still get state reimbursement for the services they provide on behalf of a DCF contractor.

The state’s two case management contractors that handle most foster care and adoption placements – currently KVC Kansas and St. Francis Community Services – are excluded from the protections. Those contractors must serve all prospective foster parents and adoptive families referred to them by under DCF’s “no eject, no reject” policy.

Madeline Fox is a reporter for the Kansas News Service. You can reach her on Twitter @maddycfox.

OTTAWA COUNTY —It took the severe weather season awhile to get started in Kansas this year, and it started with vengeance across central Kansas on Tuesday. There were several large tornadoes that touched down Tuesday.

The first was reported in Cloud County. Another tornado touched down in Ottawa County followed by another in Clay County. As of late Tuesday evening there were no reports of injuries but reports of property damage, power poles and power lines were down across some roads.  A home near the Ottawa County town of Tescott was damaged.

Authorities will continue to assess damage on Wednesday.

The storms caused a semi to jackknife on I-70 in northwest Ellsworth  blocked traffic for a time. When the severe storms moved through Barton County there was a report of hail the size of grapefruits. Heavy rain with estimates of 3-5 inches prompted flash flood warnings for Osborne and Mitchell Counties.

The National Weather Service expects another round of severe weather Wednesday across much of Kansas.

STAFFORD COUNTY — Fire crews continue to monitor a large grass fire in Stafford County.

Shortly after noon Monday, fire crews were dispatched to a brush/grass fire in the north part of Stafford county, according to Stafford County Fire and EMS.

When fire crews arrived on scene the fire had spread rapidly through grasses and quickly made it’s way into a large group of trees.

Crews from Seward, Hudson, St. John, and Great Bend worked the scene throughout the day. Crews from Hudson and Stafford relieved the day crews and remained on scene throughout the night to monitor hotspots and make sure the fire does not jump lines.

An acreage has not been determined at this time, however, the fire has burned close to a mile in length.

Crews from Great Bend Fire/EMS, and Kansas Highway Patrol assisted in fighting the fire.