Red tape is costing 45,000-plus Medicaid coverage in Kansas. The state blames slow mail
The Kansas Medicaid disenrollment rate is one of the highest in the country. Almost two-thirds of Kansans have lost coverage due to procedural issues.
When Emily Redden’s Kansas Medicaid renewal packet arrived in the mail at the beginning of May, she could barely tell what it was.
“It was a big yellow manila envelope,” Redden said. “And it was very black and discolored and tattered up. … It almost looked like it was stuck in a machine of some kind.”
To make matters worse, the vital piece of mail for the single mom and her two kids arrived after the deadline to renew. Because she was unable to file the paperwork in time, Redden and her kids were temporarily disenrolled from Medicaid health care coverage on May 1.
Her family of three is among thousands of other adults and children who lost their Kansas Medicaid coverage after renewals restarted in April when temporary measures that gave more people government health insurance through the pandemic ended.
Some people lost their Medicaid coverage because of the end of the pandemic rules because Kansas never expanded the program under the Afforable Care Act. But far more — more than 45,000 — lost that coverage because of problems with paperwork. It’s unclear how many of those Kansans will ultimately qualify for Medicaid or when that will be sorted out.
Kansas started reevaluating the more than 500,000 Medicaid recipients in April and plans to take one year to complete the process.
The initial numbers of people disenrolled show about 70% lost their coverage in the first month. If that were to continue to happen, more than 200,000 Kansans will lose coverage, well over the number the Kansas Department of Health and Environment projected earlier this year.
KDHE officials did not respond to a request for comment after releasing the numbers on Friday.
KDHE has said slow mail delivery caused some of the problems. The agency said Kansas can take up to nine to 10 days to be delivered. Before to the pandemic, it would have only taken two to three days.
Molly Gotobed is the project director at the Community Health Council of Wyandotte County and the Kansas Assistance Network, an organization that helps people apply for health insurance.
She said her office has gotten hundreds of frantic calls since the Medicaid renewals started back up.
“A lot of times the question is, ‘Well, I received my packet, but it was due yesterday. So it didn’t get in the mail fast enough,’” Gotobed said. “And that can be … because of the mail system, the third party vendor, like whoever’s getting that out there.”
KDHE Medicaid Operations Deputy Director Christine Osterlund said last week that the state is giving April and May Medicaid renewals 30-day extensions to return paperwork.
“Now we’re evaluating what is our permanent solution so that we always ensure that our members get that full 30 days that they’re required to get and they need to get so they can get that information to us,” Osterlund said.
The state has yet to say if there might be more permanent adjustments to the renewal process.
The figures made public on Friday mean Kansas has one of the highest rates of Medicaid disenrollment rates in the country. A Kaiser Family Foundation analysis looked at eleven states and found disenrollment rates ranged widely between states.
In Florida and Arkansas, more than 50% of the April renewals were disenrolled. In other states like Virginia, only 10%.
KFF Medicaid Research Director Jennifer Tolbert said state-reported numbers also show large numbers of eligible people losing coverage because of procedural issues. That includes individuals unaware they needed to renew their eligibility and missing the deadline.
“Often people won’t know that they’ve been disenrolled until they go to the pharmacy to refill a prescription or go show up at the doctor’s office for a scheduled appointment,” Tolbert said.
“They can’t get that prescription filled,” she said. “They can’t see that doctor that day. So it does present a delay and a disruption in care that can be devastating for some people.”
Children are among the most likely to lose coverage, according to a study from the University of Georgetown. For Kansas and other states that have not expanded Medicaid, parents might be losing coverage but are unaware their children are still eligible.
“When we are starting to see some higher disenrollment rates among children, I think that is a cause for concern, and may indicate that some parents aren't aware of these different eligibility levels,” Tolbert said.
She said more data will be needed to see if disenrollment issues progress through the unwinding process.
“If those high procedural rates continue, that does suggest that maybe there is a fundamental problem with perhaps with how the states are conducting the renewals,” said Tolbert.
Redden said she and her kids went about three weeks without insurance after her Medicaid renewal packet arrived damaged. She had to reschedule her son’s dentist appointment and had a visit to a hospital for her daughter at a time when their Medicaid coverage was in doubt.
“I had to take her up to the Kansas City emergency room with no insurance,” she said. “I was very nervous about that.”
Redden was eventually able to get her insurance renewal paperwork in after getting some help. Her coverage was reactivated and retroactively covered the time her family was without Medicaid — including her daughter's trip to the emergency room.
“I'm persistent,” Redden said. “If someone wasn’t quite as persistent as me, I don’t know that they would have gotten it done.”
Samantha Horton reports on health for the Kansas News Service. You can follow her on Twitter @SamHorton5.
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