TOPEKA — Lengthy delays in mail delivery, unprecedented call center volume and a surge in unsigned applications contributed to the Kansas Department of Health and Environment’s tribulations in processing Medicaid renewal applications that led to suspension of benefits on procedural grounds for more than 60,000 Kansans.
KDHE’s extension of application deadlines, deployment of additional staff and collaboration with organizations working on behalf of Medicaid clients reduced obstacles to determining who could remain in Kansas’ Medicaid program, a KDHE official said. The federal government triggered the wave of eligibility reviews after ending a three-year ban imposed during the COVID-19 pandemic.
Participation in KanCare, the Medicaid program in Kansas, surged during the pandemic from 410,000 to 540,000. The nationwide process of evaluating Medicaid rolls to identify people no longer eligible, known as unwinding, began in March and must be completed in early 2024.
“Obviously, we’ve never done an unwinding before in the state of Kansas or anywhere in the nation,” said KDHE deputy secretary Christine Osterlund. “In these first four months, we’ve learned a lot. We’ve made some missteps. We’ve corrected some things.”
Rep. Brenda Landwehr, a Wichita Republican on the Legislature’s Medicaid committee, said individuals no longer eligible for KanCare should be urged to seek health insurance under provisions of the Affordable Care Act signed by President Barack Obama.
“I had some people call me that got canceled,” Landwehr said. “Four of those individuals … got Obamacare insurance. You know, one was a zero premium, one was $10 dollars and one was $15. Are we making sure that they have information so that they know that’s an option?”
Concerns expressed
Child advocacy groups have been alarmed children made up two-thirds of Kansans declared ineligible for KanCare due to procedural issues with applications, including missed deadlines and missing signatures. Those concerns were raised Wednesday and Thursday at the Capitol during meetings of the joint House and Senate committee responsible for Medicaid oversight.
“We suspect that because nearly 72% of KanCare enrollees are children, thousands of Kansas kids have already had their coverage discontinued and thousands more will in the future,” said Heather Braum, health policy director of Kansas Action for Children. “A lack of health coverage means these kids will be less likely to get medical treatments on time, will fall behind in therapies and could have the long-term trajectory of their lives negatively impacted.”
Sean Gatewood, of KanCare Advocates Network, said continuous coverage was important for children and for adults with chronic health conditions.
“We recognize the challenges that come with restarting eligibility reviews after three years of continuous coverage during the pandemic,” Gatewood said. “Our partners report that KanCare members continue to be either unaware or confused about process. Ongoing confusion among members and problems associated with paperwork issues seem to indicate the need for additional communication and outreach.”
He urged KDHE to allow the three managed-care organizations under contract with the state to operate the privatized KanCare program to work with applicants subject to renewal.
“KanCare members need a simple renewal process that is easy to complete to continue their health care, their medications and therapies,” Gatewood said.
Call center avalanche
Osterlund said KDHE decided to conduct KanCare renewals in a chronological order rather than subjectively prioritize children, people with serious medical challenges, individuals in long-term care or other populations. So far, KDHE has sent notices to individuals or families with renewal dates in April, May, June and July.
KDHE said renewal applications submitted by the deadline allowed members to retain eligibility while the renewal was processed, but the state has been instructed to sever eligibility for people who didn’t submit renewals on time. Families or persons losing KanCare eligibility for procedural issues have been given an additional 30 days to complete the application and, if approved, would have benefits backdated to address the coverage gap.
“I know there’s a gap in coverage and that’s stressful for the families,” Osterlund said. “I’m not minimizing that, but we do kind of provide this second chance, if you will, to go ahead and get that review in and be able to have their eligibility backdated.”
Osterlund said the volume of calls received by KDHE’s help line exceeded the agency’s projections by about 2,000 calls per day. She said the number of calls climbed from 19,000 in April to more than 37,000 in May and June. The response time at outset of unwinding in April was 43 minutes and more than half of callers chose to hang up.
KDHE’s call center contractor gradually reduced the call-waiting time to 12 minutes and the level of call abandonment to 16% in July by adding staff, changing work schedules and allowing for overtime.
Postal delivery
KDHE was surprised by the slow pace at which the agency’s Medicaid renewal notices were moved by the U.S. Postal Service to Kansans and how much time it took for applications to be returned once placed in the postal system. In the past, KDHE said, it might take two or three days for a KanCare client’s letter to reach Topeka.
KDHE discovered it was taking up to 10 days for mail to reach an applicant and another 10 days for mailed responses to reach clearinghouse staff in Topeka, which left applicants only 10 days during the original window to submit paperwork.
KDHE responded by pausing Medicaid discontinuances and expanded the period allotted for applicants to receive and return necessary documents, Osterlund said.
She said KDHE also encountered an increase in the proportion of applicants who didn’t sign paperwork in compliance with federal regulations. Unsigned applications must be sent back by KDHE to the family.
Given the escalation in mail sent to KDHE, officials said, agency staff were reassigned to the mailroom and eight additional scanners were obtained to address backlogs in the mail department.
Availability of data
Osterlund said KDHE’s computer system in place since 2016 wasn’t constructed to accommodate a national health emergency nor a three-year suspension of eligibility reviews for Medicaid. She said the agency had received many requests for detailed data about the unwinding that the current IT system wasn’t programmed to handle.
“It’s not even an option. We would have to do massive system changes,” she said. “Again, no one anticipated wanting the level of detail we are being asked for.”
KDHE was able in mid-July to release information on KanCare renewals by county and by age of applicants. That prompted alarm among KanCare activists who concluded two-thirds of rejections in Kansas involved children.
Osterlund cautioned unwinding information released by the U.S. Centers for Medicare and Medicaid Services showing Kansas had a 70% disenrollment rate could be misinterpreted. She said point-in-time data submitted by KDHE to CMS each month could be outdated within a single day. She said state-by-state comparisons of data from CMS weren’t typically valid given variation in how the review process was conducted.
KanCare Advocates Network and Kansas Action for Children continued to press KDHE for greater statistical insight into why people were losing Medicaid benefits. KDHE’s initial breakdown by age and county was helpful, they said, but more robust data and targeted communication could assist KanCare members in retention of coverage.
“Without aggregated demographic data,” Gatewood said, “stakeholders don’t know where to target outreach. The stakes are high for people who depend on Medicaid for their health care needs.”
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