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

TOPEKA — State officials say they have figured out why the number of Medicaid-funded nursing home stays seemed to go up 9 percent between December 2009 and January 2010. It was a paperwork blip.

“The large increase in the January 2010 count was due to a significant rise in claims adjustment activity,” Barb Conant, a spokeswoman for the Kansas Department on Aging, wrote in an email to KHI News Service.

The increase, she said, was not driven by more people moving into nursing homes, which is what some had supposed.

In December 2009, state reports showed there were 10,725 nursing home residents on Medicaid; in January 2010, the reports showed 11,711.

During this year’s legislative session, advocates for people with physical disabilities used the apparent increase to underscore the importance of funding in-home services for the elderly, which they said help people avoid having to move to a nursing home.

Earlier, spending cuts had caused KDoA and the Kansas Department of Social and Rehabilitation Services to cut in-home services for the frail elderly and other people with physical disabilities.

In February, the number of reported Medicaid-funded stays fell back to 10,388, causing advocates to wonder if hundreds of people who had given up their homes and moved to nursing homes had then died.

But the fluctuation, Conant said Thursday, was not due to cuts in-home services.

“We do expect to see an increase in nursing home admissions because of what’s happened, but usually it takes six months to a year to see,” Conant said. “It doesn’t happen all at once, like what we saw in January.”

Instead, the increase was driven by an unusually high number of billings having to be adjusted and reprocessed.

“Usually, what happens is the system counts each claim as an unduplicated individual,” said Bill McDaniel, commissioner of program and policy at KDoA. “But when a claim is adjusted and sent back through the system, it gets counted again. That’s usually not a problem because the number doesn’t vary much from month to month. But this time – in December – one of the adjustments involved 1,594 claims, the other one involved 105. That’s a lot to come through all at once.”

Some of the adjustments, McDaniel said, were two and three years in the making.

Most, he said, involved disallowed billings for therapies that weren’t covered.

In March, the reports showeded 10,356 nursing home residents on Medicaid; in April, there were 10,195, the lowest count since May 2007.

“That makes no sense to me,” said Shannon Jones, executive director at the Statewide Independent Living Council of Kansas. “I understand what Aging is saying, but still I look at the numbers every month and I see things in there that don’t match with what people are telling me is going on in the field.

“I have great concern about this because as advocates, we have to rely on the numbers in those Medicaid reports,” she said. “They’ve been the gospel but now it looks like they’re being questioned.”