Tangled Chaos of Medicaid Problems Plagues Kansas Nursing Homes

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July 19, 2016; Heartland Health Monitor

Kansas appears to have lost its grip when it comes to processing Medicaid applications, and that’s a threat to the sustainability of the state’s nursing homes. The example this article uses is a for-profit facility, but the problems are transferable to nonprofits.

Sharon Lane Health Services cares for 70 elderly and disabled residents. Due to the state’s Medicaid application backlog, the facility was waiting for Medicaid approval for 17 residents, nearly a quarter of the facility’s patient population. Approvals are supposed to take no longer than 45 days, but they have been running more like a half-year behind. This, naturally, plays havoc with cash flow and with revenue more generally, but it gets worse: All of the short-term fixes appear to have just made things a little worse.

The delay problems started last summer when the state rolled out the Kansas Eligibility Enforcement System, or KEES—a new computer program that was to have eased processing. But in January, the wait worsened when the state started to funnel all applications for Kansas Medicaid through a single clearinghouse in Topeka.

Now, delays are the norm, even for applicants who are simply moving from the community-based waiver system to institutional Medicaid with an application just one page long. “We’ve actually had four of those just this year that have taken at least six to seven months to get approved when they already had Medicaid benefits,” Rebecca Tadlock, an admissions facilitator, said. “So we’re not getting paid for those months.”

Another fix, which allowed nursing homes to seek half-payments while they waited for applications to process, became unwieldy when nursing homes were informed that they would have to pay back any payments made for people who were—in God’s good time—not approved. In fact, they would have to pay back all of the partial payments even if residents were approved and then wait to be compensated.

Meanwhile, the facilities got a bump in their reimbursements through a “bed tax” this year, but then Gov. Sam Brownback and Republican legislators approved a four percent cut in those reimbursements, making them lower than was planned for.

“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.”

“We’re really, really financially struggling,” Moore said. “The bottom line is, if we were getting paid for these people, we would be in a much better situation and be able to at least continue to be viable.”

Nursing home associations were among the first groups to feel the brunt of the state’s incompetence, because many seniors rely on Medicaid to pay for assisted living once their savings are spent.

The state came to a new level of understanding of the immediacy of these issues since Kansas Department of Health and Environment Secretary Susan Mosier revealed to federal officials last month that state backlog reports seriously underestimated the numbers of those experiencing long waits. The Kansas Disability Rights Center has now requested documents about the backlog under the Kansas Open Records Act and is urging federal officials to force a change.

Sharon Lane says they will not evict residents in need, but one staff member says, with the very real possibility of closing looming, Medicaid is increasingly taken into account when facility officials consider admitting new residents.

“We evaluate a potential new client coming in,” Moore said, “and we say, ‘Look, how many cases do we already have? How much does Medicaid already owe us? Can we bring on another?’”

The consequences of this are, quite obviously, disastrous to seniors in need. —Ruth McCambridge