Recent cuts to the state Medicaid program and changes in the application process are making things more and more difficult for nursing homes and other care providers across the state.

Recent cuts to the state Medicaid program and changes in the application process are making things more and more difficult for nursing homes and other care providers across the state. Bethany Home is no exception to the difficulties and has had to seek ways to fill the ever-increasing gap created by the delayed payments and the overall shortfall of funding.

With over 50 percent of the residents relying on Medicaid, a large portion of the Bethany Home budget depends on timely, accurate payments from the KanCare providers. In August of this year, eight residents were awaiting approval from Medicaid — one of whom has been pending since January and another since February — which means that Bethany Home has had to cover all the expenses and bills until the individuals are approved for services and payment is actually received.

While the Centers for Medicare and Medicaid Services rules dictate that applicants receive notification of eligibility within 45 days, many new applications are taking three months or more.

In the summer of 2015, after several delays, the state launched a new Medicaid computer processing program called the Kansas Eligibility Enforcement System, or KEES, but the program has been riddled with glitches and has caused a major backup of application reviews. To further compound the issues, the state funneled all applications for Kansas Medicare, or KanCare, through a single KanCare Clearinghouse in Topeka, rather than diverting a portion of the applications through the Kansas Department for Children and Families after an administrative change on Jan. 1.

At that time, the Clearinghouse took on 3,800 partially processed applications from DCF, some of which had been pending for months, in addition to the current applications for those seeking insurance for low-income pregnant women, children and parents. The Clearinghouse receives an additional 4,500 new applications each month. While the state clearinghouse has added staff and sought help from DCF, many individuals and providers are still waiting months on end for answers and help.

Marilyn Spohn, billing specialist for Bethany Home, reported, “When you call the Clearinghouse, the lines are constantly busy. If you do get through to a customer service representative, it is very limited as to what they can help you with. It seems they really can only tell you if the application has been received, is in process, is waiting on information from applicant, or waiting to be reviewed.”

The delays are not only affecting new applications, but also the processing of changes that need to be made to existing Medicaid cases. Failure to make some of these changes in a timely manner is, in fact, costing the state money that will never be recovered.

In hopes of securing more federal dollars, nursing home providers agreed to more than double a self-imposed provider assessment fee, or Bed Tax, effective July 1; however, when Kansas Gov. Sam Brownback and many Republican legislators approved a 4.4 percent cut in those reimbursements, the overall result made for a smaller-than-expected increase.

According to Kris Erickson, CEO of Bethany Home, “The cuts made by the governor cost Bethany Home over $150,000 that could have been used for resident care and left a $350,000 shortfall between the annual cost of providing care and the current reimbursement rate. We are working on ways to make sure everyone receives the care they need, but the governor and legislature sent a clear message that they do not care about Kansas’ elders.”

Despite the bleak outlook, there may be hope on the horizon. LeadingAge Kansas, a group that advocates for nonprofit nursing homes, recently sent letters to the federal Centers for Medicare and Medicaid Services and the state’s U.S. House congressional delegation, asking them to intervene.

“These delays and mistakes have become a crisis for nursing homes holding millions of dollars in uncompensated care,” wrote Debra Zehr, the group’s president and CEO. “Medicaid-pending elders are being denied care in all corners of the state because homes cannot afford to take on any more liability.”

The letters and communication from families, elders, providers, and advocacy groups is working. On Aug. 4 and 5, the Robert G. (Bob) Bethell Joint Committee on Home and Community Based Services and KanCare Oversight met to discuss the ongoing issues with Medicaid, specifically the eligibility determination backlog and recent program cuts. 

The committee heard testimony from advocates and providers about the financial losses caused by unfair denials of Medicaid applications, the effect on seniors when nursing homes no longer admit Medicaid pending residents and how that trend will continue even when the backlog is cleared, and systemic problems within the new eligibility process, and how that must be remedied to avoid any backlogs in the future.

The committee was outraged by the effects the backlog had on nursing homes and the vulnerable seniors they serve and has demanded action from the Kansas Department of Health and Environment and directed them to meet with LeadingAge Kansas and the Kansas Health Care Association to roll out a genuine advance payment option to ease the burden on nursing home providers.

An elder law attorney, Molly Wood, is working with the Kansas Disability Rights Center to file a class action lawsuit against the state of Kansas on behalf of all of the people waiting more than 45 days for eligibility determinations.

This is a civil rights suit through the Disability Rights Center, so fees and expenses will not fall on the people being represented, and the lawsuit will not be pursuing any type of monetary damages.

The goal, however, is to help stop the financial bleeding for providers and assure resolution of the eligibility determination backlog. The lawsuit also allows the opportunity to hold state agencies accountable and for Medicaid pending cases to be resolved without having to pay a lawyer to help.

Once an eligibility determination has been made, that applicant will drop out of the lawsuit. The state will likely work to quickly resolve as many cases as possible to prevent the suit from materializing.

If you, or someone you know has been pending Medicaid for more than 45 days or has had significant issues with the KanCare process and are interested in finding out more about the class action lawsuit, contact Molly Wood at MWood@stevensbrand.com or 785-843-0811.