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Kansas officials brief Committee on Welfare Reform on Medicaid enrollment, funding and managed care
Summary
State Medicaid officials and the Kansas Health Institute reviewed how KanCare is funded, enrollment trends and managed care operations, telling lawmakers that federal rules, state plan amendments and capitation rates shape provider reimbursements and program changes.
Bobbi Graff Hendrickson, deputy Medicaid director at the Kansas Department of Health and Environment, and Sheena Schmidt, senior analyst and strategy team leader for access to care at the Kansas Health Institute, told the Committee on Welfare Reform that Kansas’ Medicaid program (KanCare) serves hundreds of thousands of residents and is governed by federal and state rules that determine funding and benefits.
Hendrickson told lawmakers that Medicaid is an entitlement and that any person who meets eligibility rules must be served. “Medicaid is an entitlement program,” she said. She detailed statutory and regulatory steps required for structural changes, saying state reorganizations and rate changes require state plan amendments filed with the Centers for Medicare & Medicaid Services (CMS).
The presentation summarized enrollment and funding figures current to December 2024 and fiscal 2023 data in the Kansas Health Institute primer. Hendrickson said Kansas covered “over 363,000 people on Medicaid, over 61,000 children in CHIP, and almost 16,000 folks in our M CHIP program.” Schmidt said enrollment peaked during the COVID-era continuous coverage provision and reached about 529,000 in 2023, then declined during federal unwinding and redeterminations.
Why this matters: Medicaid is a large state-federal program that pays for medical and long-term care for low-income people, pregnant women, older adults and people with disabilities. Funding formulas — including the federal medical assistance percentage (FMAP) — directly affect how much Kansas must budget for provider payments and for the managed care organizations (MCOs) that administer most benefits under KanCare.
Key facts from the presentations
- Federal-state match: Hendrickson described the federal share commonly as about 62% for Medicaid; Schmidt provided a more precise figure used in planning: 61.87% for Kansas. For CHIP, Schmidt said the federal match was about 73.31%.
- Managed care: Kansas operates KanCare as a capitated managed-care program. Schmidt said roughly 90.2% of state Medicaid payments were for managed-care services in recent data, with MCOs responsible for most medical and long-term care payments. Hendrickson explained the state must submit actuarially sound capitation rates to CMS and that CMS and the Office of Management and Budget review those rates.
- Services covered: Hendrickson said Kansas covers required Medicaid services and many optional services (for example, prescription drugs and physical therapy) that the state chooses to include. She noted that failure to update rates (for example, durable medical equipment) risks federal match dollars.
- Program history and changes: Both presenters noted that Medicaid joined the Social Security Act in 1965; Kansas adopted a Medicaid state plan in 1967 and CHIP in 1998. Schmidt summarized KanCare’s introduction in January 2013 and the start of eligibility redeterminations when the federal public health emergency ended in April 2023.
What lawmakers asked and what officials said
Committee members pressed officials about the mechanics behind provider reimbursement increases and how state budgeting and federal matching interact. Hendrickson and Schmidt said the state legislature sets provider reimbursement increases; those increases raise total program costs, and the FMAP determines what share the federal government pays. As Schmidt told the committee, “When the state raises a provider rate, then the MCOs have to pay more. Yes. And so generally the state, as part of caseloads, that rate that we pay the MCOs will go up.”
Officials also stressed that the state plan is a binding contract with CMS and that certain program changes require either state plan amendments or waivers approved by CMS.
Ending note
Schmidt said KHI plans a next update to its Medicaid primer in January 2026 and encouraged lawmakers to request additional, more granular data if desired. The presenters said they were available to respond to follow-up technical and fiscal questions from the committee.
