Kansas Seeking Solutions To Medicaid Backlog

Kansas Department of Health and Environment Secretary Susan Mosier said last week that she’s open to ideas to streamline the state's current backlog of Medicaid applicants, including presumed Medicaid eligibility for nursing home residents.

When asked about a temporary lifeline for nursing homes drowning in uncompensated care while the department works through a computer system transition, Mosier said it was a “good concept” and that she liked the idea.

She said she would discuss it with Mike Randol, director of KDHE’s Division of Health Care Finance.

“We need to have mitigating actions,” Mosier said. “We are mitigating, but other ideas are welcome so that we can take care of people, because that’s the ultimate goal.”

‘Hobbled by a broken system’

Mosier’s words came as a relief to nursing home representatives frustrated by months of agency inaction as their members’ bills pile up.

“We’re very supportive of that idea,” said Cindy Luxem, president and chief executive of the Kansas Health Care Association, which represents for-profit nursing homes. “Something just needs to happen. The folks in our homes are getting the care, but it’s truly not fair. These folks have such a low margin anyway, and we’re expecting these caregivers to do so much with so little. Basically people are looking the other way to say, ‘We’ll get you paid eventually.’”

Deb Zehr, president and chief executive of LeadingAge Kansas, which represents nonprofit nursing homes, said her organization’s facilities are for frail seniors who need around-the-clock care.

Delaying admittance while they wait months for Medicaid applications to be processed results in suffering and even the possibility of death, she said.

“The state needs to act immediately, but they are hobbled by a broken system and a backlog of 10,000 cases,” Zehr said. “The only way to help seniors needing nursing care now is to grant presumptive Medicaid eligibility for those with pending cases, as well as to seniors applying for Medicaid before KDHE has the backlog cleared.”

Nursing homes groups trace the Medicaid problems to June when the state began to use the Kansas Eligibility Enforcement System, or KEES, to process applications and renewals.

Accenture, a state contractor, created KEES. After the system’s long-delayed rollout, state workers who use KEES were forced to learn dozens of workarounds — some of them 10 or more steps long — to make it function.

A backlog began to form, and after KDHE took over all eligibility processing last month it burgeoned to almost 10,000 applications.

Medicaid in Kansas is a privatized program known as KanCare, and it serves mainly elderly and disabled Kansans and pregnant women and children. By last month, organizations that represent those groups reported that applications that used to take seven to 10 days to process were taking three months or longer. And some said Kansans who had been on Medicaid for years were being dropped with little or no warning because their renewals hadn’t been processed.

Nursing homes were hit particularly hard because many of their residents rely on Medicaid payments after they exhaust other funds.

Luxem said some of the nursing home companies she represents have forwarded to her “tremendous accounts receivable” that she has shared with KDHE this week.

“The folks at KDHE right now are really trying to be helpful, and actually we understand that maybe a few of the things are starting to get un-logjammed,” Luxem said. “But it sure is a drag (that) we need to raise this kind of fuss just to get the system to work.”

Reaching out to legislators

After KDHE took over all Medicaid processing, Kansans who were having problems were told to call a single 800 number for the KanCare Clearinghouse, a KDHE outpost run by state contractor Maximus.

But individual Kansans reported hours-long wait times on hold and unreturned messages — the same problems a 2008 audit revealed about Maximus when it ran the children’s health care program help line for the state.

Ray Flickner, who received about two weeks’ notice that his 84-year-old mother’s Medicaid was about to expire, said he received no help from the KanCare Clearinghouse until he contacted his state legislator, Rep. Mark Hutton, a Wichita Republican.

His mother’s Medicaid coverage since has been restored.

“I’m glad I got it taken care of, but I worry about the other folks who don’t know that’s an option,” Flickner said.

Haylie Colby, a social worker at the University of Kansas Cancer Center, said she was successful in getting 64-year-old leukemia survivor Ellen Brannan’s coverage restored only after enlisting the help of Rep. Barbara Bollier, a Mission Hills Republican.

But Colby is working with another patient from Wichita who needs a bone marrow transplant due to multiple myeloma and has been waiting on Medicaid coverage since August.

“They’re ready to proceed, but she doesn’t have insurance so they can’t, really,” Colby said. “Medically, she’s ready to go.”

Colby welcomed news of a possible amnesty or presumed eligibility for nursing home residents.

“That’s excellent, that’s huge,” Colby said. “That’s the most vulnerable of all of us.”

System still an issue

Mosier said KDHE is bringing on more staff and redoubling its training to try to speed the Medicaid processing. Once KDHE gets caught up, she said the application process should improve.

“We’ve got an effort that we started in October in terms of eliminating the backlog,” Mosier said. “Eliminating the backlog is what will solve many, if not all, of these issues.”

The agency’s information technology experts and Accenture are working to make KEES more user-friendly.

However, internal documents show that problems with the system continue.

A document dated Jan. 25 provided to KHI News Service by an employee who works with the system and requested anonymity listed 67 “Defect Resolutions” stretched over five pages. Another release of fixes is scheduled for mid-February.

In an email sent Thursday to dozens of KDHE and Accenture employees, including Mosier, Jenifer Telshaw, KDHE’s head of KEES production, outlined a problem that was keeping employees from accessing KEES and the document scanning software that feeds information into the system.

“We have reports that staff cannot access KEES or ImageNow,” Telshaw wrote. “It has been verified that KEES is available but it appears that there (is) a connection issue. We are currently investigating the issue and will let you know when the issue has been resolved.”

The processing delays, while causing problems for Medicaid-eligible Kansans and their providers, have been a small revenue boon for the state at a time when budgets are tight.

Gov. Sam Brownback’s supplemental budget for the fiscal year that begins July 1 assumes $3 million in Medicaid savings “as enrollment eligibility continues to lag since implementing KEES.”

Zehr said her organization had taken note of that budget provision and its implication that the issues with Medicaid processing could drag into 2017.

“If the administration truly believes that these delays are going to last up to another 17 months, they will be saving money on the backs of humans in crisis,” Zehr said.

The KHI News Service is an editorially independent initiative of the Kansas Health Institute.