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Families and providers warn rapid shift to conflict‑free targeted case management could disrupt services
Summary
Parents, case managers and providers told a Kansas committee that a federal-driven move to conflict‑free targeted case management risks diverting services, creating new ‘‘invisible’’ waiting lists and breaking long‑standing caregiver relationships unless the state phases changes, uses exemptions where necessary and invests in capacity.
Kansas families, service providers and case managers urged the Legislature's interim committee to slow the transition to federally required conflict‑free targeted case management (TCM), citing risks that rapid change would disrupt services for people with intellectual and developmental disabilities (IDD).
Speakers said the state must pair any policy changes with concrete capacity building, phased timelines and narrow exemptions so people who rely on long‑term relationships with case managers do not lose essential supports.
The issue stems from the federal Centers for Medicare & Medicaid Services (CMS) requirements tied to the home‑and‑community‑based services (HCBS) settings rule. KDADS (Kansas Department for Aging and Disability Services) staff told the committee the state must remove conflicts of interest in case management to keep federal Medicaid funding.
"We support conflict‑free case management, but we need a phased plan and supports in place," said Jeff, a TCM supervisor at Cottonwood Incorporated, who warned that Cottonwood’s plan to divest TCM services today would create hundreds more people waiting for new case managers in his area. "If divestiture occurs without absorptive capacity in the community, we will double the waiting list in some counties."
Parents and guardians described the personal consequences of severing long‑term TCM relationships. Julie Richardson DeMarco said her brother, who has severe autism, has relied on an embedded TCM who knows his nonverbal cues and coordinates staff in real time; she said a remote or newly assigned independent case manager could not provide that level of immediate crisis intervention. "This knowledge does not come from reports gathered twice a year by a remote TCM," she said.
Providers and CDDOs (Community Developmental Disabilities Organizations) told lawmakers that the statewide numbers are uneven: some counties have multiple independent TCM providers and open referral capacity, while others — including rural and frontier counties — have only one provider, meaning a divestiture there would leave no local option. Ron Fugate, a Family Advisory Council member, reported calls to county case management firms showing limited room to accept new referrals compared with the number of clients that would need reassignment.
Multiple provider witnesses said mitigation approaches used in other states — including an "any willing and qualified provider" exemption for areas lacking options — have been approved by CMS and could limit harm in thin markets. Elizabeth Forslund, who manages Wyoming's HCBS waivers, testified that Wyoming implemented conflict‑free TCM after a formal transition plan and has not needed to use a statutory exception; she emphasized a fixed timeline, stakeholder input and monitoring.
KDADS Commissioner Michelle Hayden (LTSS commissioner) told the committee the agency is compiling data about county‑level case management capacity, working with CDDOs and preparing phased corrective actions and a roadmap. She acknowledged providers' concerns and said KDADS is contracting for planning and capacity grants but did not provide a fixed date for completion of the statewide transition plan.
Committee members pressed KDADS for timelines and additional data. Lawmakers asked for county‑level breakdowns of number of TCMs, caseloads, which agencies are closed to new referrals, and a projection of how many additional independent case managers would be needed to absorb clients if provider‑based TCMs divest.
Stakeholders urged practical steps: (1) collect and publish county‑level TCM capacity and referral availability; (2) adopt a phased implementation (many suggested 3–5 years); (3) build and fund workforce capacity, including grant programs to jump‑start independent TCMs; (4) adopt narrow, documented exceptions (any‑willing‑and‑qualified provider) in thin markets; and (5) ensure clear, regular communication to families and guardians about any required changes.
Several speakers said the state already has a waiting list for TCM referrals in some areas; they warned that poorly timed change could produce an "invisible" waiting list — people who have been offered funding but cannot find a case manager or direct support workforce to deliver services.
KDADS reiterated that the state must comply with CMS to avoid federal funding risk, and that modernization includes complementary efforts such as the Community Support Waiver and workforce initiatives.
The committee recommended KDADS produce targeted data on TCM supply and demand by county, publish a draft phased corrective action plan for public comment, and continue stakeholder work groups to design mitigation steps that preserve continuity when possible.
