The state’s Medicaid application backlog is making work more stressful for Angela Moore, executive director of Sharon Lane Health Services in Shawnee.
Moore’s nursing home has 110 employees caring for about 70 elderly and disabled residents, and she has cash flow worries because of persistent problems with the state’s Medicaid eligibility system.
At one point recently she was waiting on Medicaid coverage approval for 17 residents — which means Sharon Lane was providing free care for almost one-fourth of its clients.
Nursing homes got an increase in their reimbursements through a "bed tax" this year, but Gov. Sam Brownback and Republican legislators also approved a 4 percent cut in those reimbursements. That made the increase less than expected and made the eligibility problems even harder to absorb.
“We’re really, really financially struggling,” Moore said. “The bottom line is, if we were getting paid for these people, we would be in a much better situation and be able to at least continue to be viable.”
A state spokeswoman said via email that administrators have been briefed on the situation, Sharon Lane’s cases have been assigned to be worked and most of the pending applications will be processed soon.
Sharon Lane provides a window into the consequences of Medicaid eligibility problems that have been brewing for more than a year.
Last summer the state rolled out a new Medicaid processing computer program called the Kansas Eligibility Enforcement System, or KEES. The delays that have caused thousands of Medicaid applications to get backed up started soon after. They worsened in January when the state began funneling all applications for Kansas Medicaid, or KanCare, through a single KanCare Clearinghouse at Forbes Field in Topeka.
Nursing home associations were among the first groups to raise alarms about long waits, because many Kansans rely on Medicaid to pay for assisted living once their savings are spent.
The state added and shifted staff to try to resolve the backlog and offered a new method for nursing homes to seek half-payments while they wait for applications to process.
But that has not quelled concerns so far and pressure is building on the state to do more, especially since Kansas Department of Health and Environment Secretary Susan Mosier revealed to federal officials last month that reports showing the backlog receding were erroneous and the number of Kansans waiting was actually several times larger than previously reported.
In response, the Kansas Disability Rights Center requested documents about the backlog under the Kansas Open Records Act and urged federal officials to take stronger action to ensure prompt processing of Medicaid applications.
LeadingAge Kansas, a group that advocates for nonprofit nursing homes, sent letters last week to the federal Centers for Medicare and Medicaid Services and the state’s U.S. House congressional delegation, asking them to intervene.
“These delays and mistakes have become a crisis for nursing homes holding millions of dollars in uncompensated care,” wrote Debra Zehr, the group’s president and CEO. “Medicaid-pending elders are being denied care in all corners of the state because homes cannot afford to take on any more liability.”
Long waits, incorrect denials
Sharon Lane belongs to a different nursing home organization, the Kansas Health Care Association. But it has the same problems, according to Rebecca Tadlock, the facility’s admissions coordinator.
Tadlock helps prospective and current Sharon Lane residents with their Medicaid applications.
Some new Medicaid applications are simply taking an extraordinarily long time, she said — a half-year or more when CMS rules dictate no longer than 45 days.
That’s true even when the applicants are moving from the home and community-based waiver system, another Medicaid program, into institutional Medicaid. In those cases the application is much shorter, just one page.
But the wait for processing is the same.
“We’ve actually had four of those just this year that have taken at least six to seven months to get approved when they already had Medicaid benefits,” Tadlock said. “So we’re not getting paid for those months.”
Then there are errors that the state is slow to correct, she said.
Sometimes applications come back with a request for additional information that already has been provided, Tadlock said.
In one case she completed a Medicaid application for an elderly couple, one of whom was moving into Sharon Lane while the other was staying at home with the help of Medicaid services.
The state determined both eligible, but switched their information.
“We’ve actually talked to them about this for three months, and they’re still not fixed,” Tadlock said. “So they have Medicaid, but we can’t bill it because they processed it incorrectly.”
Then there’s the curious case of Barbara Burger.
Burger was on Medicaid and had been living at Sharon Lane for more than a year when she received notice that she was losing her coverage.
Her annual review was denied because the state said she no longer was living at the facility.
Burger was there Thursday and showed no signs of leaving. She’s elderly, on oxygen and uses a wheelchair to get around.
“Yeah, they have a little green man who comes around and takes me out every evening so I don’t have to spend the night here,” Burger joked. “So they can’t claim I’m here and get the money. I mean, that makes as much sense as anything else I can come up with.”
Burger said she’s worried and angry about losing the benefits she worked for all her life.
“Of course it’s stressful,” she said. “I’m wondering where I’m going to live, how I’m going to eat. I have some severe medical problems. Who’s going to deal with those?”
Sharon Lane is not about to kick out residents like Burger, but Moore said the problems with Medicaid are increasingly a factor when facility officials consider new residents.
“We evaluate a potential new client coming in,” Moore said, “and we say, ‘Look, how many cases do we already have? How much does Medicaid already owe us? Can we bring on another?’”
That means some Kansans might have to look for a different facility or struggle to find any nursing home that will take in their loved ones, especially if they have complex medical needs.
There are other potential health consequences for frail Kansans. For some, losing Medicaid coverage also means losing the ability to pay premiums for Medicare Part B and Part D, which cover outpatient care and prescription drugs.
Advance payment pitfalls
The possibility of having to close Sharon Lane is very real, Moore said, but she and her staff are trying to stave it off. They’ve spent hours on the phone with the KanCare Clearinghouse, the outpost near Topeka’s Forbes Field that processes Medicaid applications and renewals.
They’ve contacted KDHE officials. They’ve sought help from legislators and asked residents and their families to contact their lawmakers as well.
The efforts have had some effect. By Thursday the number of Sharon Lane residents awaiting Medicaid coverage was down to 13.
One thing they haven’t done is apply for the half-payments for residents whose Medicaid applications are pending.
Amy Turgon, Sharon Lane’s director of accounting, said there a couple of pitfalls in the state’s advance payment system. If the facility accepts the payments for a resident whose Medicaid application eventually is denied, it has to pay back that money.
“When you call the Clearinghouse, you’re told, ‘I cannot fix the problem, but I can take down your concerns.’”- Rebecca Tadlock, admissions coordinator at Sharon Lane Health Services
If the facility accepts the payments and the resident later is deemed eligible, the facility still has to pay back the money — at least temporarily.
“They don’t just pay the other half,” Turgon said. “They take it back and then reprocess the claim. … We need to have more control over our cash flow.”
Instead, Moore and her staff have focused on working with the KanCare Clearinghouse to try to get the applications processed.
Like other Kansans, they say they’ve been put on hold for long periods and received little help from the Clearinghouse, which is run by another state contractor, Maximus.
“When you call the Clearinghouse, you’re told, ‘I cannot fix the problem, but I can take down your concerns,’” Tadlock said.
Moore said the state’s customer service was far more efficient at local Kansas Department for Children and Families offices, which used to be able to process Medicaid applications before they were all sent to the Clearinghouse.
“You cannot speak to someone and try to work through an application (now),” Moore said.
The most effective advocacy they’ve had, Moore said, is from residents and their families contacting their legislators.
Through those efforts, several state officials became involved, including Kim Burnam, the director of Medicaid eligibility.
State Sen. Mary Pilcher-Cook, a Shawnee Republican whose district includes Sharon Lane, acknowledged that the Medicaid problems have been frustrating for residents and their families.
“It would certainly be a loss and disruption for everyone if Sharon Lane decides to close, and I hope that does not happen,” Pilcher-Cook said. “The state is making progress and working on getting these issues resolved in the near future.”
State Rep. John Rubin, a Shawnee Republican who represents Sharon Lane, said he would talk with Mosier about the facility’s struggles. He said he had contacted KDHE about another facility in similar straits and the agency has been helpful there.
“But it shouldn’t take the intervention of a legislator, on a case-by-case-by-case basis, to get that done,” Rubin said. “I would hate to see Sharon Lane close. They provide an important service in my district.”