Legislators grilled a state contractor Thursday about problems with the Medicaid application process and the backlog that has thousands of Kansans waiting for coverage.
Rep. Dan Hawkins, chairman of the Robert G. (Bob) Bethell Joint Committee on Home and Community Based Services and KanCare Oversight, arranged for the committee to tour the KanCare Clearinghouse where Medicaid applications are processed.
Hawkins told leaders of Maximus, the contractor that staffs the Clearinghouse, that he receives calls daily from applicants stuck in the backlog. One family called him on behalf of a loved one who had been waiting since October.
“They’re now dead,” said Hawkins, a Wichita Republican. “They already died, and they’re still not through the system.”
The contractor’s explanations for the backlog were not new: the rocky rollout last summer of a new computer system to process the applications coupled with an ill-timed administrative change that funneled all applications through the Clearinghouse.
But legislators heard more detailed information about how those two challenges caused the backlog to balloon.
In Kansas, Medicaid is a managed care program called KanCare that is administered by three private insurance companies. But those companies don’t handle the application process.
Maximus does that. An international company that does only government contracting, Maximus has 327 employees at the KanCare Clearinghouse at Forbes Field in south Topeka.
They receive KanCare applications there and begin processing them before passing them on to state employees for final approval. Maximus also staffs a customer service call center for KanCare applicants.
Maximus has done that since 1998 for certain types of Medicaid applications: those seeking insurance for low-income pregnant women, children and parents who fall under the jurisdiction of the Kansas Department of Health and Environment.
Other applications for elderly and disabled Kansans and those seeking long-term care in nursing homes were processed by the Kansas Department for Children and Families until the administrative change Jan. 1.
On that day, the KanCare Clearinghouse took on 3,800 partially processed applications from DCF. Some of those applications had been pending for months.
Since January, employees at the Clearinghouse have tried to work through those, plus an average of about 4,500 new applications each month that previously would have gone to DCF.
Maximus initially added 20 new employees to handle the increased workload.
“Should we have hired more people sooner?” asked Ilene Baylinson, general manager of U.S. health services for Maximus. “Probably.”
The company eventually brought on another 50.
“Should we have hired more people sooner? Probably.”- Ilene Baylinson, general manager of U.S. health services for Maximus
The applications for Kansans who are elderly, disabled or in need of long-term care are far more complex than the family medical applications. Baylinson said it can take months of training to get new hires up to speed.
Meanwhile, existing employees still were getting accustomed to the new software, the Kansas Eligibility Enforcement System, and the workarounds it requires.
By March the backlog of applications waiting for processing had passed 18,000, including about 7,700 that had been out for more than the 45-day federal limit.
DCF sent about 30 workers to the Clearinghouse to take up the elderly, disabled and long-term care applications that month, after federal officials sent a letter to KDHE expressing concern about the backlog. The number of DCF employees helping has since increased to 50.
Federal government’s role
The federal government also received some of the blame Thursday. The open enrollment period for insurance through the Affordable Care Act exacerbated the backlog when the online marketplace directed thousands of Kansans who hadn’t known they were eligible for Medicaid into the application process.
Maximus officials also told legislators that federal rules are the reason the elderly and disabled Medicaid applications are so complex and require hundreds of pages of documents outlining financial assets. Applicants and their family members sometimes struggle to find the right documents, which delays the process.
But committee members questioned whether Maximus employees were sufficiently trained to help.
Hawkins said one family that called him had been asked three times to provide the same document — a document the family had provided each time.
“Why is that happening?” Hawkins asked.
“It should not be happening,” Baylinson said. “Our job is to make sure that doesn’t happen. If those cases are happening, we should know about it. And if there’s an error on our part, we should fix it.”
Rep. Barbara Ballard, a Democrat from Lawrence, told Baylinson she’d received similar calls.
“I’ll just tell you: It is happening,” Ballard said.
Sen. Laura Kelly, a Democrat from Topeka, asked if legislators could contact Maximus directly about constituent concerns. But KDHE official John Monroe said he would field them.
KDHE also acts as the go-between for Maximus and Accenture, a separate state contractor that developed the KEES software.
During Thursday’s tour, a Maximus employee told legislators that the software is an upgrade compared to the previous system, but it still has issues that require workarounds.
Baylinson said KDHE has been great at relaying concerns from Maximus to Accenture. But she said the programmers who developed the technology could have benefited from earlier contact with the people who would have to use it.
“In a perfect world, we would have sat down with Accenture ahead of time,” Baylinson said.
Representatives of Kansas nursing homes and community mental health centers said they remain concerned about the backlog and the length of time it’s taking to get Kansans covered by Medicaid.
But state officials say they should have the backlog resolved by October, and Baylinson said the Clearinghouse experience will continue to improve.
“This is fixable,” Baylinson said. “This is fixable, and we will fix it. You have our commitment.”