TOPEKA, Kan. (AP) — Advocates say family members have been asked to accept plans of care for disabled Kansas residents under the state’s Medicaid program without knowing whether services will be cut.

The Kansas City Star reports that independent case managers in Johnson County say the program has become less collaborative and more secretive for people with disabilities since 2013. That’s when the state turned over its management to three private insurance companies.

The privatized program is known as KanCare and covers more than 400,000 people.

About 20,000 Kansas residents with disabilities rely on KanCare for services such as bathing, dressing and tube feedings to live at home rather than in an institution.

Family members report being asked to sign blank pages in care plans.

The state says it is addressing the concerns.