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CMS wants plan to fix KanCare backlog

Federal official pens letter to KDHE asking for bi-weekly updates on progress

By Andy Marso | March 11, 2016

CMS wants plan to fix KanCare backlog
Photo by KHI News Service Susan Mosier, secretary of the Kansas Department of Health and Environment, responded last week to a federal official's letter seeking information on efforts to fix a backlog in Kansas Medicaid applications.

Federal officials are concerned about a growing backlog of Kansas Medicaid applications and have asked state leaders to provide regular updates about what they're doing to fix the problem.

James Scott, associate regional administrator for the federal Centers for Medicare and Medicaid Services sent a letter to Kansas Department of Health and Environment officials Feb 17, citing concerns about “recent reports of the Medicaid application backlog in the state of Kansas.”

Scott asked KDHE to submit within 14 days a plan to correct the backlog.

He also asked the agency to address issues at the customer service call center, or Clearinghouse, for KanCare, the state's privatized Medicaid program.

“Based on recent articles it can take hours for a beneficiary to get through to a KanCare representative,” Scott wrote. “Please provide call center response times and dropped call rates as well as an action plan on how the KanCare Clearinghouse plans to decrease the call times for beneficiaries.”

In a response dated March 4, KDHE secretary Susan Mosier said the agency has added 20 full-time staff members to process applications and 19 more for the call center, in addition to implementing other reforms.

The state’s response also shows that the number of unprocessed applications ballooned from about 10,000 at the end of January to 18,216 by mid-February. Precisely 7,745 of those had been pending for more than 45 days, which is the most allowed under CMS rules unless the applicant needs a disability determination.

The call center is being run by a state contractor, Maximus, which reported average hold times of about 20 minutes for the month of February. However, some callers were kept on hold for almost an hour and a half.

Mosier’s letter says the backlog resulted from a rush of 13,000 Medicaid applications during the Affordable Care Act’s open enrollment which ran from November through January.

The letter does not mention a computer system switch last summer that state officials have previously said contributed to the backlog.

Gov. Sam Brownback, in his budgets for the current fiscal year and the next, has banked a total of $10 million in Medicaid savings because of lagging enrollment since the implementation of the Kansas Eligibility Enforcement System, or KEES.

Scott’s letter asks state officials to set a date for eliminating the backlog but Mosier didn’t specify one in her response


Nursing home groups unsatisfied

In Kansas, Medicaid serves about 450,000 low-income children, pregnant women, people with disabilities and the elderly.

Scott’s letter requests that the state submit information on the backlog on a bi-weekly basis. He also asks state officials to describe how they plan to address unreimbursed care provided to people whose Medicaid applications are pending.

That request is of particular interest to nursing homes, which rely heavily on Medicaid and are carrying, in some cases, more than $1 million in unpaid bills.

The state’s response, which was to tell Scott that providers would be reimbursed retroactively once Medicaid applications have been processed, did not satisfy representatives of nursing home associations.

Rachel Monger, director of government affairs for LeadingAge Kansas, said the state is already required to retroactively reimburse nursing facilities and it doesn’t solve their current cash flow issues.

“The entire issue we are having is that providers are being forced to provide uncompensated care, and elders are being turned away from care, until their application is processed,” Monger said. “Our providers need payment now.”

Retroactive payments might help providers of services that allow seniors to stay in their homes.

Monger’s group, which represents non-profit nursing homes, and the Kansas Health Care Association, which represents for-profit homes, have asked the administration to give presumptive Medicaid eligibility to their residents.

Photo by KHI News Service Cindy Luxem, president and CEO of the Kansas Health Care Association, says federal involvement in the Medicaid backlog is a good sign.

View larger photo

Cindy Luxem, executive director of the KHCA, said her organization has heard little about the state’s response to CMS, but some of the state’s previous efforts to help have not lived up to expectations.

She said KHCA and LeadingAge met with KDHE officials recently and were told that while the backlog persists, no one waiting on a Medicaid review will be dropped.

“As soon as we send that (message) out (to members) we get an email from a member who had three folks drop off the Medicaid rolls since the first of March,” Luxem said.

Luxem said she welcomes the involvement of the federal government, which funds about 60 percent of Medicaid in Kansas.

“It’s a good sign,” Luxem said. “Something’s going to happen.”

Mitzi McFatrich, who runs an advocacy group for nursing home residents called Kansas Advocates for Better Care, said something needs to happen soon.

Her group has documented instances of frail and elderly Kansans unable to find nursing facilities that will take them while their Medicaid applications are pending for months.

“It is inexcusable that the state hasn't followed its own rules and federal law, and a sad commentary that someone from the federal government has to point that out,” McFatrich said. “We remain hopeful but skeptical until we see the State take action and clear the backlog.”