The backlog of applications at the Kansas Family Medical Clearinghouse isn’t expected to go away for another year. Carla Deckert, a project manager for the private company that runs the clearinghouse, shows a stack of documents faxed to the clearinghouse in February. Every document that comes into the clearinghouse must have a hard copy placed in a file. This stack represents roughly four days’ worth of received documents. (Thad Allton/KHI)
By Dave Ranney
KHI News Service
TOPEKA, March 12
Since last July, 20,000 Kansans
children, mostly
have fallen from the state”s Medicaid rolls.
“Wow, that”s a lot,” said Sara Anderson, a spokeswoman for the Missouri Department of Social Services.
In Missouri, she said, only 69 children have been dropped from the state”s Medicaid rolls since last July.
Nebraska has lost fewer than 600.
Iowa officials figure they”ve lost around 6,000 children
more than Nebraska and Missouri, but considerably less than Kansas.
The losses, state officials said, are driven by new federal laws that require parents to show proof of their children”s citizenship
birth certificates, usually
and identities.
“It”s definitely a barrier for families,” said Carrie Fitzgerald, senior health policy associate at the Child and Family Policy Center in Des Moines, Iowa.
In an effort to insure more children and contain the costs of uncompensated care, which drive up health care costs for all, Kansas and other states have been pushing to enroll as many eligible children as possible.
So why are the numbers of children in Kansas pushed from the rolls so much higher than in Iowa, Nebraska or Missouri?
Trying harder?
“Two reasons,” said Marcia Nielsen, executive director at the
Kansas Health Policy Authority
. “Because of the way our eligibility system is set up, we have been able to identify
far more quickly than most states
how many people are losing benefits.
“Second, other states have not implemented all the same systems that Kansas has
for example, California hasn”t implemented any system yet,” Nielsen said.
In Kansas, the health policy authority runs the state”s Medicaid program.
The new federal law was meant to assure that illegal aliens weren”t using government services. But officials here and elsewhere in the country believe the new requirement is simply raising hurdles for persons who are eligible but have difficulty meeting the paperwork standards, often because they can”t readily produce a birth certificate or other documents.
It”s possible, Nielsen said, that more people have been dropped from the rolls in Kansas simply because the state has been more rigid in its interpretation of the federal requirements than other states.
But there”s a reason for that, she said. Over the past year, federal audits have caused the state to forfeit tens of millions of dollars it received for services that did not meet Medicaid criteria. Other audits are the subject of ongoing negotiations between CMS and the health policy authority.
These audits could prove just as costly. The health policy authority, Nielsen said, should not put the state in a position of appearing lax in its enforcement federal rules and regulations.
“We have been working with CMS (Centers for Medicare and Medicaid Services) very closely to resolve outstanding audits and deferrals, and we feel strongly that we”ve got to follow the letter of the law,” she said.
Elsewhere
Nebraska hasn”t been as aggressive as Kansas in its enforcement. It hasn”t denied eligibility to anyone yet, pending completion of state regulations.
“We”ve not been taking any adverse action (against applicants)
our regulations aren”t in place yet,” said George Kahlandt, administrator of economic assistance units at the Nebraska Department of Health and Human Services.
Sara Anderson, from the Missouri Department of Social Services, said the citizenship requirement hasn”t had much impact in Missouri.
“We”ve been requiring some form of identification for a long, long time for years,” she said. “So when the law changed (July 1), it wasn”t that drastic for us.”
Before July 1, Kansas parents could vouch for their children”s citizenship and identity by signing a sworn statement.
But in Missouri, Anderson said, parents were expected to take their children”s birth certificates to the “family support division office” in their county.
Workers in these offices are charged with processing and approving Medicaid applications.
That”s not how it”s done in Kansas. Here, applicants from across the state are expected to send their applications to the Kansas Family Medical Clearinghouse in Topeka.
The clearinghouse processes 85 percent of the state”s Medicaid application. The rest go through regional offices of the Kansas Department of Social and Rehabilitation Services.
In Missouri, each county has a welfare office. Kansas, however, began consolidating its offices in the 1990s. It now has 43 offices in 105 counties.
Clearinghouse woes
Jennine Morrone, a social worker at the Community Health Center of Southeast Kansas, steers the clinic”s patients toward the nearest SRS office.
“The clearinghouse doesn”t work,” said Morrone, who spent 30 years with SRS before semi-retiring. “First of all, they never see the client
that”s my biggest complaint. I tell people to call the clearinghouse and they can”t get through. The line”s busy, it”s always busy.”
That”s because applicants have flooded the clearinghouse with letters, faxes and telephone calls.
Before the citizenship requirement, all Medicaid applications were processed in three to four weeks. Now, two- and three-month delays are not unusual.
“It can be two months before they let you know you didn”t send in everything you”re suppose to send in,” Morrone said.
Our fault
Kansas has only itself to blame for the backlog, said Robert Harder, a former SRS secretary who now lobbies for the United Methodist Church of Kansas.
“What tends to get overlooked in all this is that we”ve privatized
the clearinghouse isn”t a state agency, it”s run by Maximus, a private contractor,” Harder said.
“I”m sure they”re good people and I”m sure they”re doing all they can. But if the clearinghouse was part of a state agency, there”s no way this would be tolerated,” he said. “Privatization opens the door to buck-passing.”
Missouri, Nebraska and Iowa don”t rely on a central clearinghouse. Instead, their county welfare offices process the applications.
“We have 103 offices in 99 counties,” said Anita Smith, chief of the Iowa Department of Human Services” Bureau of Medicaid Services.
But Smith said her eligibility workers, too, are dealing with “tons of pending applications. We”re looking at a backlog of, I”m guessing, 60 to 90 days.”
Like Kansas” clearinghouse, Iowa”s eligibility workers have access to the state”s vital-statistics database, allowing them to confirm a birth certificate without having to wait on a parent.
“Our success rate is 94.3 percent,” Smith said. “That”s really helped a lot.”
Kansas” success rate is around 70 percent. Reasons for the disparity are unclear.
Feds bristle
Contacted by KHI News Service, federal officials bristled at the health policy authority”s assertion that the 20,000-person drop in Medicaid enrollment is due to the citizenship requirement.
“Out of the 20,000, only 2,000 are actual denials, the rest are backlogged,” said Mary Kahn, a spokeswoman for CMS headquarters in Baltimore.
And the backlog, Kahn said, is due the clearinghouse being understaffed.
Kansas” energies, she said, would be better spent addressing the clearinghouse”s troubles than on panning the citizenship requirement.
“There is no data showing the denial rate in Kansas is disproportionate,” Kahn said. “The law is very specific. There is not a lot of wiggle room.”
-Dave Ranney is a staff writer for KHI News Service, which specializes in coverage of health issues facing Kansans. He can be reached at
dranney@khi.org
or at 785-233-5443, ext. 128.