In early March, I wrote an article about changes in the State of Kansas that increased the complexity of obtaining Medicaid benefits. My article was prompted by several investigative articles appearing in The Kansas City Star, finding multiple problems with the Kansas system. (The Kansas City Star, “KanCare Changes Leave Seniors Struggling to Keep Medicaid Coverage,” by Andy Marso, February 22, 2018. That article was a follow-up to another article by Mr. Marso, “What’s the Matter with KanCare? Challenges on Four Fronts,” The Kansas City Star, February 22, 2017.)
The Director of Communications (Angela de Rocha) of the Kansas Department for Aging and Disability Services responded to my article by way of a letter to the Editor. She stated that my article was “wrong, inaccurate and misleading.” The truth is, her response was “wrong, inaccurate and misleading.”
Before I get into some of the specifics, it is important to point out that though the system is flawed, it has many good people within it trying to make it work and trying to help consumers. On the legal side, Brian Vazquez and Loren Snell are bright, reasonable, and “see the big picture.” Breanna Dorman is a go-to person to get things done through the KanCare system. Frankly, I do not know what we would do without these individuals.
Now, to Ms. de Rocha’s letter.
1. “Medicaid… has nothing to do with federal deficit reduction legislation.” This is a most surprising statement. In February of 2006, the Deficit Reduction Act was passed (known as the DRA of 2005; Senate Bill 1932 of the 109th Congress). It is considered by those working with the elderly and Medicaid as one of the most landmark changes to Medicaid law and state programs. States were required to adopt its provisions. It changed Medicaid eligibility rules, including the look-back period (from 36 months to 60 months) and the “uncompensated transfer” definition. It changed the start date of Medicaid eligibility, restricted home exemption rules, changed Home and Community-Based Services Medicaid rules, restricted the use of annuities and promissory notes, and so on. Frankly, there is no way to understand Medicaid without understanding the rules modified or created by the DRA. Clearly, Medicaid has and always will have a lot to do with federal deficit reduction legislation.
2. “Kansas has never provided health care in ‘local Medicaid offices’.” First, that was not the statement in my article. The article did say that Medicaid offices were closed and replaced with a system centralized in Topeka. That is absolutely correct. Previously, there were local offices staffed with local experts who determined Medicaid eligibility.
These offices were operated by the Kansas Department of Social and Rehabilitation Services (SRS), which was the predecessor to the Kansas Department for Children and Families (DCF).
3. “Kansas has not ‘turned over management of Medicaid’ to a company called Maximus.” Medicaid applications used to be handled in local communities. Now, through the KanCare Clearinghouse, Medicaid application processing is mostly staffed by a private contractor, Maximus. Under Maximus’ agreement with the State, it oversees most aspects of Medicaid, including application determinations and redeterminations, though the final determination is supposed to be made by a State employee. (Kansas Department of Health and Environment, Policy Clarification 2017-07-01). Maximus is not doing its job. In fact, the State has now threatened to fine Maximus $250,000 a day for its failure to properly operate the Clearinghouse (The Kansas City Star, “Kansas tells Medicaid contractor: Shape up, or face millions in fines,” by Jonathan Shorman, February 16, 2018).
4. “Health outcomes for Medicaid beneficiaries…are significantly better under KanCare than they were under the old system.” I am speechless about this comment by de Rocha. It is just so incorrect. Last year, the federal government, through the Centers for Medicare and Medicaid Services (CMS), investigated the KanCare program. It found the KanCare program in “non-compliance…with federal Medicaid statutes and regulations. This non-compliance… places the health, welfare, and safety of KanCare beneficiaries at risk and requires immediate action.” (Letter to Susan Mosier, Secretary and State health Officer, from James G. Scott, Associate Regional Administrator for Medicaid and Children’s Health Operations, dated January 13, 2017.)
The fiasco of the KanCare system has been discussed in news articles across the State. The problems persist. It grows tiresome when State officials say the system is delivering better services when the opposite is true. Someone needs to speak out.
My original article suggested that as a starting point to fix the system we return the processing of applications to local offices where consumers could meet face to face with real people. A worker would be assigned to a case to help the applicant through the process. House Minority Leader Jim Ward said it well. “This idea that we can consolidate all this out into a building (in Topeka) when we had an infrastructure of local agencies, local groups, local persons that was working fine. We created the most inefficient system.” (See The Kansas City Star article, “Kansas tells Medicaid contractor: Shape up, or face millions in fines,” by Jonathan Shorman, February 16, 2018.)
It is going to take all of us to raise Cain with our elected officials. The KanCare system must be fixed or replaced.
Randy Clinkscales of Clinkscales Elder Law Practice, PA, Hays, Kansas, is an elder care attorney, practicing in western Kansas. To contact him, please send an email to [email protected]. Disclaimer: The information in the column is for general information purposes and does not constitute legal advice. Each case is different and outcomes depend on the fact of each case and the then applicable law. For specific questions, you should contact a qualified attorney.