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For One Family, Move To Kansas Meant Medicaid Delays

KanCare_backlog_Sykes.jpg
Andy Marso
/
Kansas News Service

All that Michael Sykes has to show for his months-long quest to get his mother’s nursing home bed covered by KanCare is a pile of paperwork.

Sykes has already appealed an initial denial of his mom’s coverage and been turned down again. He’s mulling his options. But even before the denials, he was struggling to get answers.

“From that point, from the May 25 application, we did not receive any notification other than requests for information which constituted me faxing them well over 200 pages of documents, trying to meet their requirements so they could make a determination on Mom," he says.

A 172-day wait

Sykes’ saga began when he moved his family from Oklahoma to Kansas last year. Medicaid covered his mom’s nursing home in Oklahoma, but it’s a state-run program, so he had to apply for the Kansas version once they got here.

Under federal law, Kansas was supposed to send a yes or no response within 45 days.

“And it was actually 172 days," Sykes remembers. "I received another letter requesting more information and that’s when I made a trip to Topeka.”

It was a 90-minute drive to the KanCare Clearinghouse, where his mom’s application was being processed.

It’s not a trip he would have had to make a couple of years ago, when long-term care applications were processed at local offices run by the Kansas Department of Children and Families -- including one near Sykes' home in Olathe.

But in 2015, Gov. Sam Brownback signed an executive order diverting all applications through a single Clearinghouse staffed by a private contractor within the Department of Health and Environment.

Related: What's The Matter With KanCare? Challenges On Four Fronts

The facility is at Forbes Field, an Air National Guard outpost on the far south edge of Topeka. It’s not built for walk-ins, but Sykes walked in anyway.

"I refused, basically, to leave their offices until I had some kind of an answer," he says.

Complex applications

The answer was that Sykes’ mom didn’t qualify for KanCare until she spent down a trust fund she had inherited. That decision underscores the complexity of long-term care applications. A lawyer who works for the state of Oklahoma told Sykes the trust was fine for Medicaid coverage there. But in Kansas it was deemed disqualifying and it took the state’s contractor, Maximus, almost four times longer than federal rules allow to determine that.

Lori Palmer, the chief financial officer of the nursing home chain Medicalodges, and other nursing home administrators say Clearinghouse workers don’t have the experience to know what documentation to ask for, or the customer contact to make sure they get it promptly.

“They took away the face-to-face encounter that a person, an elderly person, has to go in and ask for help," she said after a hearing at the Statehouse last month.

Palmer’s company has 21 nursing homes in Kansas, including the Eudora facility where Sykes' mother, Evelyn, lives.

They’ve been caring for her at Medicalodges, but they haven’t been getting paid.

By the end of 2016 Medicalodges had provided more than $1 million in uncompensated care for 112 Kansas residents whose Medicaid applications were pending. Eighty-three of those had been pending more than 45 days. In other states where Medicalodges does business, it rarely takes more than a month.

“Missouri and Oklahoma, we don’t have these problems," Palmer said. "We talk to one person. We call. We get it done."

Seeking improvements

Some nursing homes have stopped accepting new residents whose KanCare applications are pending, because the processing takes so long.

KDHE Secretary Susan Mosier says the intent of Brownback’s executive order consolidating processing of all types of KanCare applications within a single state agency was to make the process more efficient.

But after more than a year of complaints about the backlog, Mosier’s department started a pilot program with six nursing facilities. It’s more like the old Department for Children and Families model with designated staffers handling long-term care applications. She says it’s working well.

But for now, it’s still an extended battle for some people to even find out if they can get KanCare coverage.

And when they do get coverage then the next battle starts for providers: getting claims paid.

Andy Marso is a reporter for KMUW's Kansas News Service, a collaboration of KMUW, Kansas Public Radio and KCUR covering health, education and politics in Kansas. You can reach him on Twitter @andymarso.