How Long Does It Take To Get Approved For Kancare

Thousands of Kansans seeking Medicaid benefits are being forced to wait months because of continuing problems with a new estimator arrangement and a alter in the state agency responsible for handling some eligibility determinations.

The application backlog began to form in July when state officials moved Medicaid eligibility processing to the long-delayed Kansas Eligibility Enforcement Organization, or KEES. The software switch forced employees to utilize dozens of time-consuming workarounds to make the arrangement part.

So on Jan. 1, the state transferred all Medicaid eligibility determination for elderly and disabled Kansans from the Kansas Department for Children and Families to the Kansas Department of Health and Environment.

Organizations that serve those populations say that since then, their clients have been improperly dropped from Medicaid, which in Kansas is a privatized program called KanCare.

But they're not the only ones reporting problems.

Pregnant women traditionally had little problem getting Medicaid in Kansas. They are presumed eligible, and by law their applications are sent to the top of the listing.

But late terminal month the Wyandotte County Fetal and Baby Bloodshed Review Board warned legislators that even those applications, which used to take seven to x days to procedure, are now taking three or four months.

"This filibuster in service is highly detrimental to meaning women, new mothers, newborns and infants," the review board's community activity team told the Articulation Committee on Home and Customs Based Services and KanCare Oversight on January. 22. "If pregnant women are unable to present a medical menu to initiate medical treatment, then prenatal intendance becomes delayed or nonexistent."

Aaron Dunkel, KDHE deputy secretarial assistant, told the group he'd look into the problem.

KDHE spokeswoman Sara Belfry said via email that the department has nigh 10,000 Medicaid applications awaiting, which is up from about 6,000 prior to taking on DCF'due south eligibility responsibilities.

Belfry said "a number of factors" contributed to the excess, including the open up enrollment flow for insurance through the healthcare.gov marketplace, which refers some Kansans to Medicaid.

"We continue to take steps to address and eliminate the pending applications for all Medicaid populations," Belfry said. "Nosotros have added and redeployed staff to increase application processing chapters and go along to make system improvements to subtract application processing times."

Nursing homes feel fiscal pinch

Meanwhile, since Jan. 1, Tower's department has instructed every Kansan having problems with Medicaid processing to call the KanCare Clearinghouse — a unmarried 800 number associated with a small KDHE outpost of 336 state and contract employees at Forbes Field in Topeka.

But the calls are ofttimes of little help, said Shari Coatney, president and master executive of the SKIL Resource Center, which serves Kansans with disabilities in southeast Kansas.

Photograph by Andy Marso Callers say they take waited for hours to talk with employees at the KanCare Clearinghouse — a small KDHE outpost at Forbes Field in Topeka — that handles bug with Medicaid coverage.

"They're telling me it's like a four-60 minutes-plus process to go ahold of a person, and and then getting your answer is a nightmare," she said.

Officials with the Kansas Wellness Care Association, which represents for-turn a profit nursing homes, and LeadingAge Kansas, which represents nonprofits — both of which rely heavily on Medicaid — tell similar stories.

Cindy Luxem, president and chief executive of KHCA, said as nursing abode residents await for or lose their Medicaid coverage, the facilities her system represents are feeling the fiscal pinch. Meadowbrook Rehabilitation Hospital in Gardner has more than $one million in unpaid services, she said, while several other facilities are eating thousands of dollars in unreimbursed costs.

Photo by KHI News Service Cindy Luxem, president and CEO of the Kansas Health Care Association, said as nursing home residents await for or lose their Medicaid coverage, the facilities her organisation represents are feeling the financial compression.

"Those are the kind of outstanding monies these homes are being asked to carry right now considering of inefficiencies in the frickin' system," Luxem said. "Our providers demand to get paid, otherwise there's no reason to stay in the KanCare program."

Rachel Monger, manager of authorities affairs for LeadingAge Kansas, said her system's members started reporting similar problems around the fourth dimension KEES went live that have "steadily worsened" since then.

For about viii months, a significant number of LeadingAge nursing homes have been carrying hundreds of thousands of dollars in outstanding bills on their books for care provided to residents waiting on their Medicaid eligibility.

As the fiscal strain grows, many facilities can no longer admit new residents if their Medicaid application is pending, she said.

"They can't take on more liability," Monger said. "And then what's actually happening is you will accept fragile elders who need intensive nursing care who are being denied access to that care because of these delays. If the homes aren't taking them, they're waiting months and months and months to get care, which is very serious."

Individual Kansans affected

Behind every complaint from groups like SKIL, KHCA and LeadingAge, there are individual Kansans struggling to pay their medical bills.

Ellen Brannan was diagnosed with acute leukemia in 2013, when she was 62 years old. She lost her house and car earlier she could get on inability and Medicaid, and she now lives with her sister in Prairie Village.

For two years Medicaid has paid for medications and treatments that go on Brannan alive. But when she went to the pharmacy earlier this month, she was told her coverage had expired.

With the help of Haylie Colby, her social worker at the Academy of Kansas Cancer Center, Brannan contacted the KanCare Clearinghouse several times to find out what happened. Later long waits on hold, the two of them finally got through to a clearinghouse worker. But that worker could only tell them that Brannan's Medicaid eligibility was "under review" and could offer no reason why.

"I but got a neb today from the hospital. They want $65,371.91 by Feb 2. … If I had my disability check become straight to them, it would take well-nigh five years (to pay off)."
- Ellen Brannan, who has acute leukemia and was told earlier in January that her Medicaid coverage expired

"She'due south under review, and they won't even let her reapply at this point," Colby said. "But she shows (up every bit) uninsured. And then any time she goes to pick up medicine, she has to pay the full cost for all of her medicine, which she doesn't have. And so, of course, any of the bills she has from KU, she shows up uninsured when she comes in for her handling."

"I just got a nib today from the hospital," Brannan said. "They want $65,371.91 by Feb 2. … If I had my disability check go straight to them, information technology would take almost five years (to pay off)."

Colby said she would work with the hospital'due south financial department to try to prevent Brannan's bill from being sent to a collection agency.

All the same, she expressed frustration that she could not do more for Brannan, who will be eligible for Medicare in March.

"She's a survivor," Colby said. "One like I haven't seen in five years of being hither, quite frankly."

A 3-manner phone call with 911

Christine Gordon's daughter, Autumn, besides is a survivor.

The Lenexa 4-twelvemonth-quondam has endured endless seizures in her cursory life — seizures that have set her dorsum physically and developmentally despite several prescription drugs for which Gordon says her daughter has at present developed a dependence.

Photo by Christine Gordon/Special to the KHI News Service Christine Gordon and her girl Fall, whose Medicaid coverage had paid for seizure treatment since the 4-year-sometime was born.

Medicaid had paid for Autumn's treatments since she was born. Merely, every bit in Brannan'due south case, that changed in January when Gordon went to refill Autumn's prescriptions and was told her girl'due south coverage ended Dec. 31.

Gordon sought an explanation. Later getting passed effectually to case workers in her girl's managed care company, Sunflower State Health Plan, their pharmacy benefits subcontractor and DCF, she chosen the clearinghouse and was on concur for two hours.

"When I was finally able to reach somebody, Autumn started to have seizures, so I had to put them on three-way with 911 because I refused to permit them off the phone after spending so long trying to become ahold of them," she said. "So she was able to hear my 911 call trying to get assist for my girl."

Gordon said the clearinghouse worker told her Fall'south Medicaid renewal course had been filled in correctly and sent in on time, but her coverage had non been renewed.

"(She said that) with the transfer from DCF to KanCare, they did not have plenty workers, the figurer system has not been working and they were not able to get reviews candy in fourth dimension," Gordon said. "However, they did not notify any of us. I had no idea Autumn had no coverage."

The worker told her she would marking Fall's example as urgent and in need of immediate attention, merely it would take at to the lowest degree two days for them to begin processing Fall'southward renewal.

Gordon'southward pharmacy has agreed to give her a partial refill of ane of Autumn'south medications without immediate payment, just can't practice that with another drug, which costs more than than $iii,000 per refill.

Gordon said she and her girl are out of options.

"She has 2 days left of her medicine, and so we're infirmary-jump," Gordon said. "If she doesn't get these medicines, this is life-threatening to her. She's addicted to them at this signal and without them she goes through withdrawal."

'A heck of a mess'

Ray Flickner of Kingman, a small-scale town near Wichita, received a little more warning about the stop of his mother's Medicaid coverage.

Flickner said he received a letter dated January. 15 letting him know that his mother'southward coverage would exist terminated at the stop of the month for failure to provide some data during the review process.

"I didn't know we were reviewing it," he said.

His mother, who is 84, has for virtually 12 years used Medicaid every bit a backstop to fill up gaps in her Medicare coverage. This is the commencement time Flickner has received such a alphabetic character.

He chosen the clearinghouse terminal week and left a voicemail after waiting on hold for an hour. He left ii more than messages after that merely as of last week had yet to get a retrieve.

Flickner initially was reluctant to go public but said someone needs to speak upward for his mom and other vulnerable Kansans who might not take people advocating for them in the Medicaid enrollment process.

"That thing is bankrupt," Flickner said. "Nosotros've got a heck of a mess."

Contacting legislators

Flickner said he had started contacting legislators about the problem.

Others are doing the same, after responses from executive branch agencies left them unsatisfied.

Coatney said SKIL repeatedly has been told that the KanCare enrollment problems volition smooth out once the transition to the new computer arrangement is complete. But she's skeptical.

"I would say it'southward gotten worse," she said. "I don't know that it won't become better. It is new and in that location's ever quirks for new systems, but correct at present it's hard for us to come across that lite."

Coatney's organization reached out to Senate Vice President Jeff Male monarch, an Independence Republican who represents SKIL's area. King said final week that he'south aware of SKIL'southward concerns.

Brannan and Colby spoke with Rep. Barbara Bollier, a Republican from Mission Hills, who said Brannan'south situation is intolerable.

"It is unconscionable for a cancer patient to exist forced to spend precious energy worrying about insurance coverage when her efforts should exist focused on fighting her disease," Bollier said.

Linda MowBray, who works with Luxem as director of the Kansas Center for Assisted Living, said a lot of the bug go back to the KEES switch. The country had time to piece of work things out with providers who have residents who should be on Medicaid just hasn't done and so, she said.

"Everybody knew there was a glitch in the system," MowBray said. "But instead of saying, 'Allow's accept some amnesty, let'south have some cooperation, allow's send this information out again and endeavor to get it correct,' they're now simply rudimentarily denying claims."

Luxem questioned the wisdom of providing i KanCare Clearinghouse helpline number for more than 400,000 Kansans on Medicaid plus thousands of providers.

She said KHCA volition exist looking for help from Rep. Will Carpenter, a Republican from El Dorado, who chairs the House Social Services Budget Commission.

Monger said LeadingAge Kansas besides is looking to legislators for help because the executive branch has not responded speedily plenty.

"We don't desire to exist told, 'Oh just await another month or so until we work the kinks out,'" Monger said. "This is actually a systemic trouble that has been happening for eight months, and it does have actual human costs. So information technology needs to be fixed immediately, and I don't know why they're ignoring the problem."