Kansas Struggles With Medicaid Backlog

Representatives of 15 groups that advocate for Kansas Medicaid populations sent a letter to state leaders this week urging them to eliminate a Medicaid application backlog that has left thousands of Kansans awaiting coverage.

The groups have formed a coalition called the KanCare Advocates Network. They represent children, pregnant women and Kansans who are elderly or disabled.

Kansans from those populations have been waiting months, in some cases, for their Medicaid applications to process.

“These delays are placing vulnerable persons of all ages in jeopardy of short and long-term negative health outcomes due to their inability to access needed healthcare and services,” the group’s letter said.

Some members of the advocacy group plan to attend Monday’s meeting of the legislative committee that oversees KanCare, the state’s privatized Medicaid program.

Angela de Rocha, a spokeswoman for the Kansas Department for Aging and Disability Services, said state officials share the group’s concerns and are “fully committed to ensuring that Kansans receive the services they need on a timely basis.”

“We are as concerned about this as the folks that wrote that letter,” de Rocha said.

The Medicaid backlog began last summer when the state rolled out a new computer system for determining eligibility called the Kansas Eligibility Enforcement System, or KEES.

Fifteen groups that advocate for Kansas Medicaid populations — children, pregnant women and Kansans who are elderly or disabled — have formed a coalition called the KanCare Advocates Network. The sent a letter this week urging state officials to eliminate a Medicaid application backlog that has left thousands of Kansans awaiting coverage.

State employees who use KEES must learn dozens of time-consuming workarounds to circumvent defects, and the system does not always transfer applications seamlessly to another computer program that sends Medicaid cards and cuts checks to health providers.

Within months of KEES going live, organizations that serve Medicaid populations began reporting longer-than-normal application processing times.

Other factors exacerbated the problem.

On Jan. 1, the Kansas Department of Health and Environment took over responsibility for processing all Medicaid applications and annual reviews, including some previously done by the Kansas Department for Children and Families.

That created a bottleneck just as the open enrollment period for the Affordable Care Act was steering thousands of eligible Kansans toward Medicaid coverage.

By February there were more than 17,000 applications awaiting processing, including almost 8,000 that had been pending for more than the federal limit of 45 days.

That month the federal Centers for Medicare & Medicaid Services requested that state officials form a plan to address the backlog and submit twice-weekly status updates.

State Taking Steps

Internal documents and emails provided to KHI News Service show the KEES project was plagued from the beginning by lack of communication and internal strife within state agencies and between the state and its contractor, Accenture.

Two KDHE officials who appear throughout the documents have left the agency in recent weeks.

A KEES update sent April 7 to KDHE employees stated that Jenifer Telshaw had accepted a position with another state agency. Telshaw, the KEES business support manager, raised alarms about insufficient staffing throughout the testing phase of KEES.

An internal email sent Monday to KDHE workers stated that Darin Bodenhamer, the director of Medicaid eligibility, was “no longer with the agency” but provided no further details.

Emails sent while KEES was under development show that Bodenhamer clashed with Glen Yancey, the state’s leading information technology employee on the project. A KDHE employee who uses KEES and spoke on condition of anonymity said Bodenhamer was a strong voice for workers when glitches in the system made it difficult for them to process applications.

Telshaw and Bodenhamer did not respond to phone messages, and de Rocha said she could not discuss personnel issues.

De Rocha emphasized that state officials have taken a number of steps to start paring down the backlog and moderating its effects.

KDHE has added 39 employees to help process applications and answer calls on a helpline, and some DCF staff members have been shifted to help process applications.

Nursing homes, some of which have stopped taking residents with pending Medicaid applications because of uncompensated care, have been given the opportunity to apply for half-payments for residents awaiting Medicaid processing.

Meanwhile, de Rocha said state officials are working closely with Accenture to improve processing time and accuracy to stem the application backlog.

“The state realizes that this is a problem and it’s a serious problem and we take the letter (from advocates) very seriously,” de Rocha said. “We are working 24-7 to try to address this backlog problem.”

The efforts are producing results.

The state’s most recent report to CMS stated that the total number of unprocessed applications had dropped to about 15,800 by mid-March. The number of applications pending more than 45 days had dropped to about 7,380.

De Rocha said more progress has been made since then. Unprocessed applications were down to 10,807 as of Friday and the number pending 45 days or more was 5,414, she said.  

“We’re going in the right direction,” de Rocha said.

The state has reduced the number of pending applications in part by prioritizing processing them ahead of annual reviews for Medicaid beneficiaries.

Consequently, the number of unprocessed reviews has been increasing — from about 19,800 at the end of February to almost 23,000 in mid-March.

Once the backlog problems were apparent, the administration said Kansans with unprocessed reviews would not be dropped from the Medicaid rolls.

But some advocates say people they work with remain at risk of losing care if they can’t assure their providers that they still have coverage.

Provider Issues

Rosie Cooper, executive director of the Kansas Association of Centers for Independent Living, is one of the advocates who signed the letter urging elimination of the backlog.

Cooper’s organization represents 10 centers statewide that connect Kansans with disabilities to service providers who can help them with daily tasks that allow them to live independently.

She said some of the Kansans she serves are reporting that their providers are still getting “Medicaid expired” messages for clients whose reviews are caught in the backlog.

KDHE officials have been quick to clarify for providers that they are still covered, but it requires an extra phone call.

“It’s another layer,” Cooper said.

Wichita resident Robin Hartzell said he found himself in that spot in February, when he went to a doctor and was told he no longer had Medicaid.

The stakes were high because Hartzell had a surgery scheduled. Without assurance of coverage, the physicians said they might have to postpone the procedure.

Hartzell contacted KanCare ombudsman Kerrie Bacon and his state legislators, Rep. Tom Sawyer and Sen. Michael O’Donnell. With help from them and a KDHE worker, Hartzell was able to clarify that he had Medicaid coverage and get the procedure.

“It was related to that software migration,” Hartzell said. “The system just kicked me out and the IT guys had to go in there and ‘flip a switch,’ as she called it, and get me back in the system.”

Hartzell said he wanted to share his story because he feared other Medicaid recipients might not know how to navigate the system.

As the state irons out issues related to the backlog, some Kansans in need are still waiting.

Ricardo Vicens, another Wichita resident, said he applied for Medicaid in December. A massive stroke left Vicens, who is 60 years old, partially paralyzed on his left side.

Vicens needs a disability determination, which extends the federal guidelines for processing his application to 90 days. But it’s been more than 100 days and he still has not received his card or any update on his case.

Vicens said he’s confined to a wheelchair inside a home that is not accessible for people with disabilities. He’s been paying out of pocket for follow-up care at GraceMed, a community health center that allows patients without insurance to pay on a sliding scale based on income.

But he can’t afford physical therapy to try to regain some of what the stroke took from him.

“That’s my top priority, physical therapy, because I cannot move my left hand,” Vicens said. “It’s getting worse and worse.”

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