Kansas Health Institute | Information For Policy Makers. Health for Kansans.

TOPEKA — The Kansas Health Policy Authority has put together a plan for relieving the backlog of unprocessed applications for the Medicaid and Children’s Health Insurance Program.

“We’ve made some headway,” said Barb Langner, the agency’s Medicaid director.

Earlier this year, federal officials directed the health policy authority to come up with a plan after learning that 8,100 applications had been pending for more than 45 days, and that 5,300 renewals had been pending more than 45 days.

Federal regulations require states to process Medicaid and CHIP applications, including annual renewals, within 45 days.

The health policy authority forwarded its plan to the regional Centers for Medicare and Medicaid Services official in Kansas City last month.

Health policy authority officials have long blamed the backlog on rigid eligibility criteria and staffing cuts that coincided with a growing number of families applying for coverage.

The applications are processed by Policy Studies, Inc., a private contractor employed by the state.

Some details

The plan, Langer said, includes:

• Using Social Security Administration data to verify some applicants’ citizenship.

• Dropping the long-standing practice of having state workers double-check the contractor’s handling of each application; instead, applications will be spot-checked.

• Creating an “express lane” designed to let information used in applying for another benefit – food stamps, for example – be used in applying for Medicaid or CHIP.

• Allowing families to self-declare their incomes when renewing their applications, rather than requiring them to document past earnings.

In Kansas, families on Medicaid and CHIP are expected to reapply once a year.

In the past, when children on Medicaid turned 18 they were expected to apply for themselves. Now, Langner said, parents will be allowed to apply for them.

Most of the changes, she said, take advantage of streamlining provisions in the Children's Health Insurance Program Reauthorization Act of 2009.

“The objective now, I think, is not so much about keeping people out of the program who may not be eligible as it is about getting those who are eligible into the program, and giving states the tools they need to make that happen,” Langner said.

"Important steps"

The changes are long overdue, said Shannon Cotsoradis, president and chief executive officer at Kansas Action for Children.

“We applaud the health policy authority for taking these important steps,” she said. “This is really good news for children and families.”

Stories of families having to wait four and five months to hear whether their children had been approved for Medicaid or CHIP had become commonplace, Cotsoradis said.

“It important to remember that if you’re found to be eligible for Medicaid, your coverage will be retroactive,” she said. “But if you’re found to be eligible for CHIP, your coverage starts that day. It’s not retroactive, so you, as a parent, get stuck with the bill. That discourages parents from taking their kids to the doctor.”

Families eligible for CHIP have higher incomes than those eligible for Medicaid.

Langner said though the changes are expected to speed the processes for determining eligibility, they’re unlikely to eliminate the 13,400-case backlog cited by CMS.

“We know things are getting better,” Langner said, “but we also know that until there’s an ability to increase staff, the backlog to some degree will still be there. You can only process so many applications with the people you have, and that’s where we are now. They’re at maximum speed.”

The plan, she said, also calls for the health policy authority to continue seeking additional funding for the clearinghouse operation from public and private sources.

Langer said she expected CMS would approve the plan but she wasn’t sure about the timeline.

“We’re saying we’re going to do all this within a six-month window,” she said. “They may come back and say we’ve got to do more.”

No difference yet

A spokesperson for the state’s safety-net clinics said the clinic operators and their patients were more than tired of the delays.

“I know the KHPA is doing all it can, but I have to say that from this end not much has changed,” said Krista Postai, executive director at Community Health Center of Southeast Kansas in Pittsburg.

“We still have to fax things two and three times because they get lost,” Postai said. “We call the magic (telephone) numbers they give us and nothing happens. If there’s anything that complicates your application, you’ll be waiting three to four months, easy. Things may have changed internally, but for those of us on the outside they haven’t. Not yet.”

Postai is president of the board of directors of the Kansas Association for the Medically Underserved, which represents the state’s safety-net clinics.