A beleaguered state system for determining who is eligible for Medicaid has sent recipients incomplete or complex information about their benefits, according to a new state audit.
Auditors reviewed communications sent by the Kansas Eligibility Enforcement System, KEES, to beneficiaries of Kansas’ privatized Medicaid program, KanCare. They found consumer notices sometimes lacked information or wording required by policy. Notices were also overly complex, according to the audit.
“That’s all kind of a big deal. We’ve been complaining about that for some time,” said Sean Gatewood, co-administrator of KanCare Advocates Network.
The state rolled out KEES software in 2015 after numerous delays. Struggles to process eligibility then resulted in a backlog of KanCare applications that hit the bottom lines of nursing homes, making it difficult to take on residents. Gatewood expressed frustration some problems weren’t yet solved.
“You know, we’ve been after KDHE since the implementation of KanCare, since before KEES, about making things clear to people,” Gatewood said.
KDHE, or the Kansas Department for Health and Environment, and the Kansas Department for Aging and Disability Services oversee KanCare. KDADS spokeswoman Angela de Rocha said the notices consumers receive do occasionally lack some information or provide duplicate information.
“KDHE is working to fix these glitches in the system and educate the reviewers in order to make the notices more accurate, complete and understandable,” de Rocha said.
According to the audit, the notices consumers get from KEES were accurate, but not always easily understood. Six of the 18 notices auditors reviewed were missing information. In two of the 18 cases reviewed, about 11 percent, notices were missing information about why the consumer was denied eligibility.
“In both cases, the lack of an explanation could be confusing and frustrating for the consumer, and result in additional work for KDHE, the KanCare Clearinghouse, or other stakeholders involved with the state’s medical programs,” the audit says.
De Rocha said having information missing from a notice can affect consumers differently.
“If the notice is intended to inform a consumer that he or she needs to take a specific action, and that information is missing, the consumer might suffer a negative consequence, and at the least have to take the time to get their specific situation straightened out,” de Rocha said.
Four of the notices reviewed lacked instructions for consumers.
Gatewood said he thought the confusion could contribute to the backlog of KanCare applications, which has declined from its peak in 2016, because consumers struggle to understand what they need to do to gain or maintain eligibility.
KDHE Secretary Susan Mosier and Medicaid Director Mike Randol have both left this fall in the waning days of Gov. Sam Brownback’s administration. Lt. Gov. Jeff Colyer is expected to nominate Mosier’s replacement.