By CRISTINA JANNEY
Hays Post
Federal officials in mid-July decided to stop requiring Kansas to report the number of Medicaid applications waiting to be processed.
The list of those waiting to have their Medicaid enrollment forms processed has decreased.
The state has been sending reports to CMS since early 2016 when it reported more than 7,000 applications waiting more than 45 days for processing. The federal government requires Medicaid applications be processed within 45 days.
As of March, Kansas was determined to be a steady state, said Angela de Rocha, communications director and deputy secretary of the Kansas Department of Aging and Disability Services. As of July, the state had 1,428 cases pending beyond 45 days. However, de Rocha said all of the these cases had been touched. Of those cases, 1,120 applications were waiting for further information from the applicants.
Although the state has made strides in reducing the number of people waiting for applications to be processed, some are concerned about continued long wait times and a lack of continued oversight.
The state’s Medicaid system was privatized in 2011 and is now known as KanCare, a system that was championed by Lt. Gov. Jeff Colyer.
Mary Shepker, officer manager at Good Samaritan in Hays, said she has had clients who have waited 90 to 100 days for their Medicaid applications to be processed.
Good Samaritan accepts nursing care patients while their Medicaid is pending.
However, not all centers are accepting patients without Medicaid approval, said Cindy Luxem, CEO and president of the Kansas Health Care Association and Kansas Center for Assisted Living.
Those who apply for Medicaid and are successful will have their bills paid back to the date they applied. However, assisted living clients receive benefits from the date they are approved.
“What is happening now is there are people sitting in the hospital and sitting at home waiting to get their Medicaid eligibility because no one will take them because they don’t have a payer source,” Luxem said.
Shepker said Good Samaritan helps clients fill out applications and send them into the KanCare clearinghouse. Sometimes they don’t hear anything. The family or the facility tries to call, but officials can be difficult to contact, she said. Often, officials say they need further information.
Shepker said she has encountered multiple cases in which she has repeatedly sent the same information to KanCare officials and the officials repeatedly say they have not received it.
Most recently, the agency has had difficulty with faxes. Shepker said local office staff have sent faxes as many as five times in a row, and the agencies continue to say they never received them.
“Sometimes it has been 90 to 100 days before we hear anything from them, and that is with us hounding them day after day,” she said.
De Rocha said people are no longer waiting these long periods to have their applications processed. The federal government requires very detailed information from individuals who are applying for Medicaid to pay for nursing center care. She encouraged individuals to be very careful when filling out the paperwork as the applications can’t be approved until all information is received.
“People just can’t expect their applications to processed the next day,” she said. “There are too many applications in the system.”
Some nursing home residents end up not qualifying for benefits because they have too many assets. This requires what is known as a spend-down. Applicants are allowed to keep some assets such as their home, but are expected to divest themselves of most of their money and assets before they can qualify for Medicaid.
The state has developed a work group and pilot program to try to streamline the application process for those seeking Medicaid for long-term care.
The state has been spending a lot of time working cooperatively with nursing facilities and stake holders to make this process better, she said. The state has been working on a process improvement project that began last winter.
Waiting for applications to be processed can be very stressful for family members and caretakers. Some of those caretakers are spouses who themselves are in their 80s.
Until a patient is approved for Medicaid, they are listed as private pay in the Good Samaritan system. This means the patient’s guardian is receiving bills for as much as $30,000 and $45,000.
“We have spouses who are nervous they aren’t going to be able to pay $25,000 or $30,000, and they are going to have to take their loved ones back home,” Shepker said.
Luxem said one man was so distraught because he couldn’t secure a Medicaid renewal for his wife who was in nursing care he threatened suicide.
“Do they even begin to understand the stress individuals are under when they are faced with the fact they don’t know where their loved one’s care is being paid for?” she said. “We know a lot of elderly people that the most important thing to them is paying their bills. This man was being faced with not knowing how his wife was going to be cared for … It is pretty sad.”
A backlog in Medicaid applications means nursing centers are lacking essential operating funds.
Luxem said at the height of the backlog, some nursing centers were waiting on millions in unpaid Medicaid bills.
The majority of nursing center residents at one time were private pay, but that makeup has been shifting, said Shepker, who has worked with Good Samaritan for 22 years.
Good Samaritan, as of mid-July, had 30 self-pay patients and 34 Medicaid patients. The 30 self-pay included those with Medicaid pending.
Residents are also entering nursing care with much more serious health concerns, which makes care more costly and labor intensive.
Shepker said Good Samaritan is a nonprofit and has been able to maintain its budget, despite the lag in Medicaid payments, but she worries about the future.
She said she was concerned the federal government will no longer be monitoring the backlog of Medicaid applications, adding she thought the backlog would become worse without oversight.
Shepker said she thought the problem with Medicaid administration has become worse since it has moved to managed care. When the community had a local office, this did not happen, she said.
“I think Topeka needs organization,” she said.
Rep. Troy Waymaster, R-Bunker Hill, said KanCare has been the most overwhelming issue he has dealt with since Medicaid was privatized.
He said the number of people waiting to have their applications processed has decreased, but the system still has room for improvement.
Waymaster has worked with many constituents to try to correct Medicaid issues and paperwork processing errors. Constituents have been denied based on a minor error in paperwork, he said.
However, he wonders about the people who don’t contact him or who give up when they are initially denied service.
“This has been an overwhelming concern in forums, town halls and when I have been on TV. There are always questions in regards to KanCare or Medicaid,” he said. “If someone has had a problem with KanCare and can’t get it resolved, I would hope they would reach out to me or their legislator so it can be addressed. We hope to make it better.”
Waymaster said he also is concerned about the ability of nursing homes to absorb costs when Medicaid payments are delayed because of paperwork errors and processing lags.
“It is very tough on nursing homes in western Kansas,” he said. “They may not be able to absorb three to four months (of unpaid bills).”
Rep. Eber Phelps, D-Hays, said he did not recall being contacted by constituents with concerns about Medicaid applications. However, he said he did continue support the expansion of Medicaid in the state.
He said he thought Medicaid expansion will likely return as an issues early in the next Legislative session, but he was unsure if further efforts to expand Medicaid will meet resistance from Colyer as he assumes the governor’s role. Gov. Sam Brownback has accepted a position as Ambassador at Large for International Religious Freedom and is anticipated to leave his post this fall.
Luxem said she is optimistic the managed care organizations will be able to maintain the gains they have in place without federal oversight.
“We have worked very closely with not only the state people, but with the clearinghouse, which is where the Medicaid applications start their processing, to try to put some processes in place,”she said. “I am cautiously optimistic that they’re not going to want to go back to such rigorous reporting and they are going to make it work.”
Clarified at 10:08 a.m. Monday, Aug. 14, 2017.