Backlog plagues Medicaid clearinghouse

Before the federal law changed, it took three or four weeks for parents to learn if their children were covered by Medicaid , the government”s health insurance program for low income families.

Now, parents are likely to wait two or three months before finding out.

“We still have applications we received in October that have not been processed,” said Carla Deckert, deputy project manager at the Kansas Family Medical Clearinghouse, a Topeka-based facility that processes about 85 percent of the state”s Medicaid and State Children”s Health Insurance Program applications.

The clearinghouse is run by Maximus, a private contractor.

“It”s frightening,” Deckert said, noting that parents often put off taking a sick child to a doctor until they know if they”re covered.

Inevitably, some of these children no one knows exactly how many end up in emergency rooms, racking up bills for uncompensated care.

The cause

The delays are driven by a change in federal regulations that require Medicaid applicants to prove their children are U.S. citizens and to confirm each child”s identity.

In most cases, a birth certificate proves a child”s citizenship; immunization or school records usually meet the identity requirement.

Intended to block undocumented immigrants from receiving federal benefits, the new rules took effect July 1, 2006. Before then, parents could meet the identity and proof-of-citizenship requirements by signing sworn statements.

Children on Medicaid before July 1 will have to meet the requirements when their cases come up for annual renewal.

Under the old system, families were found to be eligible or ineligible, depending on household income. Now, each child is subject to a separate ruling.

So instead of four siblings born in three different states being the subject of a single review, they”re the subject of four reviews.

The transition to the new process has not been smooth.

Soon after the eligibility changes took effect, the clearinghouse was flooded with phone calls, faxes and mail-in applications. Online applications were no longer practical.

Reams of additional documents now have to be scanned into the computer system.

“We went from 116,000 “clicks” (pages scanned) a month to 188,000 in a single month,” Deckert said.

During a recent visit to the clearinghouse, a single day”s worth of scanned-document copies filled four white plastic boxes marked “U.S. Postal Service.”

In just two hours, the clearinghouse”s industrial-size fax machine generated a six-inch stack of correspondence that had to be logged, sorted and distributed.

Before the new rules, a parent calling the clearinghouse often had to wait two minutes to speak to a case worker. Now, the average wait is 13 minutes.

“And that”s on a good day,” Deckert said.

The effect

In the past seven months, the clearinghouse has gone from having no backlog every application and renewal was processed in three to four weeks to sitting on thousands of cases.

“In the first two or three months, this backlog of 9,000 to 10,000 applications set in that we haven”t been able to get rid of,” Deckert said.

The new regulations were published June 17, 2006, leaving state officials three weeks to implement them.

There was no way, Maximus officials said, that they could reconfigure their computer system, retrain their 115 workers and add equipment in three weeks all while keeping pace with the 9,000 applications and renewals arriving each month.

“If we”d had 60 days instead of three weeks, it would have been so much better,” said Christiane Swartz, Medicaid operations director at the Kansas Health Policy Authority.

“Instead of always being in a reactive mode, we could have had some things in place we have now.”

Adding to the clearinghouse”s troubles, the mandate was unfunded. States are expected to find the money in their own budgets to pay for whatever system and manpower changes were needed to comply with the new regulations.

The health policy authority last fall used its marketing budget $178,000 to hire four additional clearinghouse workers. As a result, KHPA officials say they no longer have funds to reach out to the thousands of families whose children are eligible for either Medicaid but not yet enrolled.

To help it comply with the new citizenship rule, the health policy authority asked Gov. Kathleen Sebelius for about $1 million in state funds for additional staff and equipment $495,000 in Fiscal 2007; $572,000 in Fiscal 2008.

The governor recommended some of what the health policy authority requested in the Fiscal Year 2008 budget she submitted to the Legislature. Her budget, if adopted by the Legislature, would provide an additional $81,105 in the current budget year and $121,658 in fiscal year 2008.

Whether legislators are willing to meet the health authority”s request remains to be seen.

A key lawmaker, Rep. Bob Bethell, R-Alden, chairman of the House Social Services Budget Committee, said he”s aware of the backlog.

“When I heard about this, I figured it had more to do with people in the urban areas,” Bethell said. “But now I”m finding it affects rural people too. I”ve had constituents call me about it.”

Bethell said his committee is looking for additional funding or positions for the clearinghouse.

“We definitely have a problem,” he said.