Advocates for elderly Kansans say a number of changes the state made to streamline the Medicaid application and renewal process have actually created a maze that seniors are getting lost in.
In 2015, Kansas moved to a new computer system for applying for Kansas Medicaid, or KanCare. Then it funneled applications and annual reviews that used to be handled in regional offices into a single “KanCare Clearinghouse” in Topeka. It contracted with a company called Maximus to staff the Clearinghouse starting in 2016.
Since then the number of seniors covered by KanCare for in-home nursing help has gone down and so has the number being covered for nursing home beds. Meanwhile, the state’s population has been aging. Dan Goodman, the director of the Johnson County Area Agency on Aging, said it just doesn’t add up unless there’s a problem with the system.
“Some seniors are really having a tough time getting onto Medicaid,” Goodman said. “They get frustrated, are in poor or declining health, become defeated by the process and give up.”
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Sandra Richardson is trying not to get to that point with her husband’s annual review.
Richardson took care of her husband, Dale, in their Roeland Park home for as long as she could while a genetic neurological condition slowly paralyzed him. In 2004, when they were both in their 60s, they made the difficult decision to place him in a nearby nursing home.
When Dale’s coverage came up for review in October, Richardson was told she had to use some of his social security check to pay his nursing home bills or he would lose coverage. She and her attorney are sure it’s a mistake because she’s under the income level that is protected by Medicaid’s “spousal impoverishment” provisions.
In the past, Dale would have had a case worker in a local office they could have gone to for in-person help.
Instead, Richardson said the past several months have been a nightmare, as they play phone tag with a revolving door of Maximus employees in Topeka, none of whom know her husband’s case and one of whom suggested she just go on welfare.
“I can’t sleep,” Richardson said. “I wake up all hours of the night. I think about this 24/7.”
Angela de Rocha, a spokeswoman for state agencies, said there are other factors behind the decrease in seniors on Medicaid, including an increase in those being served by another government program that provides alternatives to nursing homes.
But she said the state agrees that “the shortcomings of the Clearinghouse account for a significant portion” of it.
“These populations have a more difficult time navigating the eligibility process,” de Rocha said.
When Gov. Sam Brownback established the Clearinghouse, he said it would make things more efficient.
But the computer system roll-out was rocky and complaints about the Clearinghouse began almost immediately. A backlog of Medicaid applications pending past the 45-day federal limit quickly formed and has never been fully resolved. Nursing home administrators have repeatedly said it’s hurting them financially and the delays have caused some homes to limit the number of people with pending Medicaid applications they will take.
The Kansas Department of Health and Environment, which oversees the Clearinghouse, and Maximus have said multiple times they’re working to fix the problems. This year they’re assigning a specific case worker to each nursing facility to allow nursing home billing departments to have a single point of contact that knows their cases.
Maximus spokeswoman Lisa Miles said that has been a success.
“Nursing home facilities are reporting faster processing times for applications and quicker response times to their inquiries,” Miles said. “In a recent survey of nursing home facilities, 91 percent of participants felt that the Clearinghouse was ‘responsive’ to ‘extremely responsive’ to their questions and concerns related to their cases and inquiries.”
De Rocha said KDHE is considering moving to that system for individual Kansans like Richardson, as well.
Since Brownback left for a post in the Donald Trump administration, a new slate of KDHE leaders working under Gov. Jeff Colyer have said they’re also considering getting rid of Maximus.
Jon Hamdorf, the state’s Medicaid director, told legislators last week that the company is falling well short of its contract requirements. He threatened hefty retroactive fines if Maximus doesn’t improve by June and also said he also would consider canceling the contract and handing the Clearinghouse back to state workers.
Goodman and others who work in the nonprofit aging agencies want the state to go a step further and restore case management payments they once had to help seniors with their Medicaid coverage. Goodman said they’d also like to see the state restore the local eligibility offices that took walk-in appointments.
Richardson said she’d welcome that.
“They really need to change this,” Richardson said. “Instead of trying to make it better, they just made it worse. They should have just left it alone.”