A backlog started a year ago when the state changed over to a new computer system for determining Medicaid eligibility which was something the Commonwealth of Virginia undertook around the same time. The Virginia transition was met with some challenges. I personally experienced a four month delay in the processing of one of my client's Medicaid applications. I was told that the delay was caused by moving from manual forms social workers were used to a computerized system that will eventually be faster and less subjective have had a fairly steep learning curb for employees. Fortunately, Virginia did not experience the same type of system glitches that Kansas saw however.
The new Kansas Eligibility Enforcement System, or KEES, was long delayed while state workers and a private company, Accenture, attempted to sort out technical issues. Unfortunately, many issues remained when the program went live in July 2015. Shortly thereafter, the state moved responsibility for application processing to the Kansas Department of Health and Environment. This included a portion of the workload previously processed by the Kansas Department for Children and Families.
The switch and program bugs created a logjam when the annual Affordable Care Act open enrollment period drove thousands of potential applicants to Medicaid—also known as KanCare, which is Kansas’ privatized managed care program. In February, there were more than 18,000 new KanCare applications waiting to be processed, including nearly 8,000 that were beyond the 45-day federal limit. There were another 18,000 annual reviews for existing KanCare clients also awaiting processing, with more than 10,000 of those left pending for 45 days or more.
At this stage, the state took steps to address the backlog. The federal Centers for Medicare and Medicaid Services asked for twice-monthly updates on progress.
KDHE added more employees and moved some existing employees to assist in processing. DCF employees with experience in the application process for the elderly and disabled were repurposed to help at the KanCare Clearinghouse. This is a processing center overseen by KDHE and partially staffed by a private contractor. In addition, the state established an appeals process for nursing homes to seek partial reimbursement for residents waiting months for KanCare coverage.
KDHE officials said the number of unprocessed reviews grew to about 30,000 in early May, but the number of new pending applications decreased to only 3,500, with 2,081 of them out 45 days or more. The state says the number of pending applications for 15 days or fewer dropped from 3,000 in mid-March to just 600 in May.
The state is working to make the application process easier. It’s expanding access to paper applications at Aging and Disability Resource Centers, local health departments, and DCF service centers to address complaints from Kansans without internet access.
The total Medicaid enrollment in Kansas has increased to 434,000 at the end of April and surpassed the pre-KEES monthly averages. It dipped to about 403,000 at the height of the backlog.
Reference: kcur.org (June 15, 2016) “Kansas Works To Clear Medicaid Backlog But Complaints Continue”