KHI News Service

HealthWave backlog eliminated

Kansas Health Policy Authority meets March target of ending application delays

By Dave Ranney | March 31, 2011

State health officials today said that they've cleared the backlog that over the past year delayed the processing of thousands of applications for HealthWave, the combined programs that provide health coverage for low-income children and pregnant women.

“We are completely caught up,” said Kansas Medicaid Director Barb Langer.

For much of last summer, more than 18,500 applications had been stuck for more than 45 days at the Kansas Health Policy Authority’s application clearinghouse. Today, officials said, that number is down to 104. The health policy authority oversees the state's Medicaid and HealthWave programs.

“We’ll never get down to zero because there will always be a certain number of applications that come in without all the required information,” Langer said. “Getting down to 104 is about a close as you’re going to get.”

The number of applications awaiting processing at the clearinghouse peaked at 35,227 last fall. It’s now down to about 2,000.

Federal regulations give states 45 days to determine if an applicant is eligible for services.

In April 2010, federal officials told the health policy authority to come up with a plan for reducing the backlog.

The agency's plan, submitted to federal officials in July 2010, called for eliminating backlog by March 2011.

“They’re very happy now,” Langner said. “In fact, we’ll be filing a March report and then, after that, it’ll be ‘problem erased.’”

Agency officials blamed the backlog on increased numbers of families losing private health insurance as unemployment increased during the recession, cuts in state spending that reduced agency staffing, and a July 1 change in the contractors that run day-to-day operation at the eligibility clearinghouse, which is located in Topeka.

“What is all comes down to, really, is resources,” Langner said. “This a ‘people thing,’ you can only do so many so fast.”

Langner said the agency had used a one-time, $2.6 million bonus from the federal government to hire and train additional clearinghouse workers.

The clearinghouse contractor, Public Solutions Inc. (PSI), also added workers, she said.

Also, PSI and the health policy authority simplified the application process and streamlined the checklist for determining eligibility.

“We’ve made lots of changes,” she said, “but this wouldn’t have happened if it weren’t for the commitment of the staff at the clearinghouse. People have been working on this – overtime and on holidays – for months.”

The efforts haven’t gone unnoticed.

“It used to be such a hassle,” said Don Stevens, a billing clerk at Southwest Boulevard Family Health Care, a safety-net clinic in Kansas City.

“I had a big, thick file full of patients who’d said they’d applied for HealthWave and had been told they were pending,” Stevens said. “So every month I’d check to see if they’d been approved. It just went on and on. Nobody seemed the know anything. The patient didn’t know if they were covered. We didn’t know if we were going to get paid. We’re a safety-net clinic, we need every dime we can get!”

Stevens said his file of patients with pending applications is no longer full.

“It’s like, one by one, they’ve all been taken care of,” he said. “We still, occasionally, see someone who says they’re pending, but those numbers aren’t anywhere near what they used to be.”

Misty Kruger, a spokeswoman for the Shawnee County Health Agency, said the Topeka-based safety-net clinic has noticed a similar decline.

“There’s been a major improvement, definitely,” Kruger said. “We’ve even some 10-day-old babies who are already in the system. That never ever happened before.”

HealthWave covers children, pregnant women, and parents.

Applicants, depending on their household incomes, are eligible for either Medicaid or the Children's Health Insurance Program. In Kansas, the two programs are marketed together under the single name of HealthWave.

The clearinghouse determines who’s eligible and for which program.

Langner said she doubted the clearinghouse would return to its 18,500-application backlog.

“Two reasons,” she said. “We’ve done a lot of streamlining and we have an experienced contractor. Unless there’s a severe reduction in resources, I don’t see it slipping back.”

HealthWave covers almost 220,000 children and 7,500 pregnant women.

Located at Topeka's Forbes Field Industrial Park, the clearinghouse, each day receives between 500 and 1,000 HealthWave applications or renewals.