Problems With Medicaid Eligibility System Leave Kansans Without Care
Thousands of Kansans seeking Medicaid benefits are being forced to wait months because of continuing problems with a new computer system and a change in the state agency responsible for handling some eligibility determinations.
The application backlog began to form in July when state officials moved Medicaid eligibility processing to the long-delayed Kansas Eligibility Enforcement System, or KEES. The software switch forced employees to use dozens of time-consuming workarounds to make the system function.
Then on Jan. 1, the state transferred all Medicaid eligibility determination for elderly and disabled Kansans from the Kansas Department for Children and Families to the Kansas Department of Health and Environment.
Organizations that serve those populations say that since then, their clients have been improperly dropped from Medicaid, which in Kansas is a privatized program called KanCare.
But they’re not the only ones reporting problems.
Pregnant women traditionally had little trouble getting Medicaid in Kansas. They are presumed eligible, and by law their applications are sent to the top of the list.
But late last month the Wyandotte County Fetal and Infant Mortality Review Board warned legislators that even those applications, which used to take seven to 10 days to process, are now taking three or four months.
“This delay in service is highly detrimental to pregnant women, new mothers, newborns and infants,” the review board’s community action team told the Joint Committee on Home and Community Based Services and KanCare Oversight on Jan. 22. “If pregnant women are unable to present a medical card to initiate medical treatment, then prenatal care becomes delayed or nonexistent.”
Aaron Dunkel, KDHE deputy secretary, told the group he’d look into the problem.
KDHE spokeswoman Sara Belfry said via email that the department has about 10,000 Medicaid applications pending, which is up from about 6,000 prior to taking on DCF’s eligibility responsibilities.
Belfry said “a number of factors” contributed to the backlog, including the open enrollment period for insurance through the healthcare.gov marketplace, which refers some Kansans to Medicaid.
“We continue to take steps to address and eliminate the pending applications for all Medicaid populations,” Belfry said. “We have added and redeployed staff to increase application processing capacity and continue to make system improvements to decrease application processing times.”
Nursing homes feeling financial pinch
Meanwhile, since Jan. 1, Belfry’s department has instructed every Kansan having problems with Medicaid processing to call the KanCare Clearinghouse — a single 800 number associated with a small KDHE outpost of 336 state and contract employees at Forbes Field in Topeka.
But the calls are often of little help, said Shari Coatney, president and chief executive of the SKIL Resource Center, which serves Kansans with disabilities in southeast Kansas.
“They’re telling me it’s like a four-hour-plus process to get ahold of a person, and then getting your answer is a nightmare,” she said.
Officials with the Kansas Health Care Association, which represents for-profit nursing homes, and LeadingAge Kansas, which represents nonprofits — both of which rely heavily on Medicaid — tell similar stories.
Cindy Luxem, president and chief executive of KHCA, said as nursing home residents wait for or lose their Medicaid coverage, the facilities her organization represents are feeling the financial pinch. Meadowbrook Rehabilitation Hospital in Gardner has more than $1 million in unpaid services, she said, while several other facilities are eating thousands of dollars in unreimbursed costs.
“Those are the kind of outstanding monies these homes are being asked to carry right now because of inefficiencies in the frickin’ system,” Luxem said. “Our providers need to get paid, otherwise there’s no reason to stay in the KanCare program.”
Rachel Monger, director of government affairs for LeadingAge Kansas, said her organization’s members started reporting similar problems around the time KEES went live that have “steadily worsened” since then.
For about eight months, a significant number of LeadingAge nursing homes have been carrying hundreds of thousands of dollars in outstanding bills on their books for care provided to residents waiting on their Medicaid eligibility.
As the financial strain grows, many facilities can no longer admit new residents if their Medicaid application is pending, she said.
“They can’t take on more liability,” Monger said. “So what’s actually happening is you will have frail elders who need intensive nursing care who are being denied access to that care because of these delays. If the homes aren’t taking them, they’re waiting months and months and months to get care, which is very serious.”
Individual Kansans affected
Behind every complaint from groups like SKIL, KHCA and LeadingAge, there are individual Kansans struggling to pay their medical bills.
Ellen Brannan was diagnosed with acute leukemia in 2013, when she was 62 years old. She lost her house and car before she could get on disability and Medicaid, and she now lives with her sister in Prairie Village.
For two years Medicaid has paid for medications and treatments that keep Brannan alive. But when she went to the pharmacy earlier this month, she was told her coverage had expired.
With the help of Haylie Colby, her social worker at the University of Kansas Cancer Center, Brannan contacted the KanCare Clearinghouse several times to find out what happened. After long waits on hold, the two of them finally got through to a clearinghouse worker. But that worker could only tell them that Brannan’s Medicaid eligibility was “under review” and could offer no reason why.
“She’s under review, and they won’t even let her reapply at this point,” Colby said. “But she shows (up as) uninsured. So any time she goes to pick up medicine, she has to pay the full cost for all of her medicine, which she doesn’t have. Then, of course, any of the bills she has from KU, she shows up uninsured when she comes in for her treatment.”
“I just got a bill today from the hospital,” Brannan said. “They want $65,371.91 by Feb 2. … If I had my disability check go straight to them, it would take almost five years (to pay off).”
Colby said she would work with the hospital’s financial department to try to prevent Brannan’s bill from being sent to a collection agency.
Still, she expressed frustration that she could not do more for Brannan, who will be eligible for Medicare in March.
“She’s a survivor,” Colby said. “One like I haven’t seen in five years of being here, quite frankly.”
A three-way call with 911
Christine Gordon’s daughter, Autumn, also is a survivor.
The Lenexa 4-year-old has endured countless seizures in her brief life — seizures that have set her back physically and developmentally despite several prescription drugs for which Gordon says her daughter has now developed a dependence.
Medicaid had paid for Autumn’s treatments since she was born. But, as in Brannan’s case, that changed in January when Gordon went to refill Autumn’s prescriptions and was told her daughter’s coverage ended Dec. 31.
Gordon sought an explanation. After getting passed around to case workers in her daughter’s managed care company, Sunflower State Health Plan, their pharmacy benefits subcontractor and DCF, she called the clearinghouse and was on hold for two hours.
“When I was finally able to reach somebody, Autumn started to have seizures, so I had to put them on three-way with 911 because I refused to let them off the phone after spending so long trying to get ahold of them,” she said. “So she was able to hear my 911 call trying to get help for my daughter.”
Gordon said the clearinghouse worker told her Autumn’s Medicaid renewal form had been filled in correctly and sent in on time, but her coverage had not been renewed.
“(She said that) with the transfer from DCF to KanCare, they did not have enough workers, the computer system has not been working and they were not able to get reviews processed in time,” Gordon said. “However, they did not notify any of us. I had no idea Autumn had no coverage.”
The worker told her she would mark Autumn’s case as urgent and in need of immediate attention, but it would take at least two days for them to begin processing Autumn’s renewal.
Gordon’s pharmacy has agreed to give her a partial refill of one of Autumn’s medications without immediate payment, but can’t do that with another drug, which costs more than $3,000 per refill.
Gordon said she and her daughter are out of options.
“She has two days left of her medicine, and then we’re hospital-bound,” Gordon said. “If she doesn’t get these medicines, this is life-threatening to her. She’s addicted to them at this point and without them she goes through withdrawal.”
‘A heck of a mess’
Ray Flickner of Kingman, a small town near Wichita, received a little more warning about the end of his mother’s Medicaid coverage.
Flickner said he received a letter dated Jan. 15 letting him know that his mother’s coverage would be terminated at the end of the month for failure to provide some information during the review process.
“I didn’t know we were reviewing it,” he said.
His mother, who is 84, has for about 12 years used Medicaid as a backstop to fill gaps in her Medicare coverage. This is the first time Flickner has received such a letter.
He called the clearinghouse last week and left a voicemail after waiting on hold for an hour. He left two more messages after that but as of last week had yet to get a call back.
Flickner initially was reluctant to go public but said someone needs to speak up for his mom and other vulnerable Kansans who might not have people advocating for them in the Medicaid enrollment process.
“That thing is broke,” Flickner said. “We’ve got a heck of a mess.”
Flickner said he had started contacting legislators about the problem.
Others are doing the same, after responses from executive branch agencies left them unsatisfied.
Coatney said SKIL repeatedly has been told that the KanCare enrollment problems will smooth out once the transition to the new computer system is complete. But she’s skeptical.
“I would say it’s gotten worse,” she said. “I don’t know that it won’t get better. It is new and there’s always quirks for new systems, but right now it’s hard for us to see that light.”
Coatney’s organization reached out to Senate Vice President Jeff King, an Independence Republican who represents SKIL’s area. King said last week that he’s aware of SKIL’s concerns.
Brannan and Colby spoke with Rep. Barbara Bollier, a Republican from Mission Hills, who said Brannan’s situation is intolerable.
“It is unconscionable for a cancer patient to be forced to spend precious energy worrying about insurance coverage when her efforts should be focused on fighting her disease,” Bollier said.
Linda MowBray, who works with Luxem as director of the Kansas Center for Assisted Living, said a lot of the problems go back to the KEES switch. The state had time to work things out with providers who have residents who should be on Medicaid but hasn’t done so, she said.
“Everybody knew there was a glitch in the system,” MowBray said. “But instead of saying, ‘Let’s have some amnesty, let’s have some cooperation, let’s send this information out again and try to get it right,’ they’re now just rudimentarily denying claims.”
Luxem questioned the wisdom of providing one KanCare Clearinghouse helpline number for more than 400,000 Kansans on Medicaid plus thousands of providers.
She said KHCA will be looking for help from Rep. Will Carpenter, a Republican from El Dorado, who chairs the House Social Services Budget Committee.
Monger said LeadingAge Kansas also is looking to legislators for help because the executive branch has not responded quickly enough.
“We don’t want to be told, ‘Oh just wait another month or so until we work the kinks out,’” Monger said. “This is actually a systemic problem that has been happening for eight months, and it does have actual human costs. So it needs to be fixed immediately, and I don’t know why they’re ignoring the problem.”
Andy Marso is a reporter for KHI News Service in Topeka, a partner in the Heartland Health Monitor team. You can reach him on Twitter @andymarso