Most of the state’s safety net clinic directors say they’re having a hard time enrolling children in HealthWave. The process for approving applications, they say, is clogged.
Two- and three-month waits are not unusual.
“Parents are getting frustrated,” said Krista Postai, executive director at the Community Health Center of Southeast Kansas, Pittsburg. “They’re giving up.”
That’s not the case at Wichita’s GraceMed Health Clinic.
“We’re in kind of a unique situation,” said GraceMed Executive Director Dave Sanford.
GraceMed is one of two safety-net clinics taking part in a multi-year experiment designed to test the benefits of a concept know as presumptive eligibility.
“Basically, what it means is that when an uninsured child comes in, we screen them and if it looks like they’re eligible, we can go ahead and issue them a temporary card,” Sanford said. “We can go ahead and see that child that day and be compensated.”
The clinic is not allowed to issue cards to children who do not appear to be eligible.
“There are criteria they have to meet,” Sanford said. “There’s a template we go through.”
After the temporary card is issued, parents are expected to fill out a HealthWave application and mail or fax it to the Kansas Family Medical Clearinghouse in Topeka.
“That’s where things seem to be breaking down,” Sanford said. “It used to be we’d hear back in two or three weeks; now, I’m told three or four months will go by before we hear anything.”
The child remains eligible — and the clinic continues to be paid for its services — unless the clearing house declares the child ineligible.
Kansas Health Policy Authority officials have blamed the delays on the state’s economic troubles causing an increase in applications while, at the same time, budget cuts have hamstrung the agency’s efforts to manage the influx.
Also taking part in the presumptive eligibility experiment:
• Via Christi Hospital, Wichita.
• Children’s Mercy Hospital, Kansas City.
• Hunter Health Clinic, Wichita.
“I would love to see presumptive eligibility go statewide,” Postai said.
That won’t happen right away. In an e-mail to KHI News Service, health policy authority officials said plans call for putting 12 state-paid eligibility workers “in the field” by spring of 2010.
How many of these workers will be officed in safety-net clinics has not been decided.
Plans also call for allowing more — but not all — safety-net clinics and hospitals to engage in presumptive eligibility.
The expansion of presumptive eligibility is complicated by a new contractor taking over the clearinghouse Jan. 1 and the health policy authority beginning a major overhaul of the computer system it use in determining eligibility.
The overhaul will be phased in over five years.
The new system will allow online applications, the current system does not.
-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.