Kansas Archives - Health Mettler Institute

April 2, 2023

Families say Kansas Medicaid red tape cuts off kids from the medical equipment they need | KCUR 89.3

OLATHE, Kansas — It’s a typical Thursday evening in the Hoffman house.

The family hangs out in the living room for a small dance party. Then one of the kids reads a book to 18-month-old Miles.

Neil and Abby Hoffman make sure Miles, who has chronic lung disease and cerebral palsy, joins in with his three siblings while sitting in his positioning chair.

“He has some vision problems,” Neil Hoffman said. “He eats through a G tube (a gastrostomy tube used to deliver food and medication directly to the stomach), has a tracheostomy tube in his throat. (He’s) ventilator dependent. So he’s basically on life support. But he’s doing really well. He’s fighting through it all.”

The coat closet in the front hallway is filled with Miles’ medical supplies. He sleeps in the dining room.

“It’s just too hard to take him up and down the stairs,” Abby Hoffman said.

What their son really needs now is a standing frame to learn how to stand and build leg muscle. With that, Miles might walk one day.

But insurance won’t pay. Miles is covered by overlapping plans — his parents’ Blue Cross Blue Shield of Kansas City policy and a second one managed by Aetna from the Kansas Medicare program, KanCare.

Blue Cross says it doesn’t cover standing frames. That passes the buck to Aetna.

Aetna might pay the $5-6,000 cost for a standing frame. But only after Blue Cross puts its denial in writing. Blue Cross won’t. And that leaves Miles in limbo.

“It’d be nice if they just talk to each other and say, ‘Hey, we’re not going to cover this, so will you?’”

Families across Kansas find themselves in similar bureaucratic dead zones, unable to get critical medical devices. The denials can spoil chances to develop at home, at school and into productive adults. And in some cases, like Miles, that first step.

Doctors, therapists and advocacy groups say the denials of prescriptions for medical equipment come too often and appear to violate at least the spirit of federal law.

The Kansas Department of Health and Environment did not respond to questions about chronic delays and denials for physician-prescribed devices by KanCare insurance companies.

Instead, in an emailed statement, KDHE said it is working to get lawmakers to address low Medicaid reimbursement rates.

“The Medicaid program needs the Legislature’s approval to increase rates to the levels our providers are asking for,” the agency said.

Wait Times

A small closet door is swung open. On it hangs a clear plastic organizer stuffed with medical supplies. Inside the closet are more shelves and plastic drawers filled with medical supplies. — The Hoffmans’ entryway coat closet has been repurposed to hold Mile’s medical supplies.

Carrie Grosdidier, an early childhood intervention occupational therapist who works with the Hoffmans, said the absence of that standing frame could have profound consequences for Miles.

“That’s impacting his ability to move forward with his outcomes, his goals, and his independence,” she said.

Cases like his can prove complicated and mean navigating through red tape. The barriers cost families life-changing equipment. Elizabeth Edwards, an attorney with the health care rights group National Health Law Program, said bureaucracy too often gets in the way of care.

“People should not be waiting … an extremely long time to get these medically necessary devices,” she said.

The federal Early and Periodic Screening, Diagnostic and Treatment law, or EPSDT, mandates children on Medicaid receive access to comprehensive equipment and services they need.

“One of the things that comes up often is whether or not the state sets the definition of medical necessity, or whether or not managed care plans have more wiggle room to define what medical necessity means,” Edwards said. “That can really inhibit whether or not something is covered by a plan.”

The insurers

A young girl wearing a purple shirt and dark jeans sits in a wheel chair. A man, standing left and a woman are attending to her, getting her situated and prepared to roll out the door of a bedroom. — Dan and Kacy Seitz get their daughter, Hudsyn, ready for the day.

Kacy and Dan Seitz have learned to navigate the system over the years while taking care of their 12-year-old daughter, Hudsyn. She suffered a brain injury at birth. The Shawnee, Kansas, family has had to get a wheelchair, a bathing chair and a stairlift.

“We’ve been on this road for about 12 years, that process is more familiar to us,” Kacy Seitz said. “For new families, that’s pretty intimidating.”

Each month, Dan Seitz talks with insurers about what the family needs for Hudson. But insurance does not cover everything each month. Sometimes it depends on how much their claims add up to in a given month and whether KanCare, the state’s Medicaid program, will cover something or the family needs to pay for things on its own.

“These are not devices that are optional for our daughter,” Kacy Seitz said. “We have to have them.”

Knowing the lengthy wait times and potential denials that can routinely come with durable medical equipment means trying to prepare well in advance.

“You almost have to think about it a year ahead of time in order to follow the existing process and get equipment on time,” Kacy Seitz said.

And sometimes they just make something themselves. They’ve placed a La-Z-Boy recliner on a wooden platform with wheels and fashioned a paper towel holder to station one of her pumps by her bed.

“Kacy’s first thought is how do we get something paid for,” Dan Seitz said. “My first thought is, ‘How can I just make it, because I already know it’s probably not gonna get paid for.’”

National Health Law Program senior policy analyst David Machledt said few people appeal their denials. It’s even more difficult for those that do not have extra support systems to help.

“(It) exacerbates some of the health disparities and access that we are seeing for people with disabilities, for people from different cultural backgrounds,” he said.

A Strained System

A small room with white walls and patterned rug has a wooden crib in it with many medical accessories like oxygen tank, chart with medical information, latex gloves, stethoscope and hand sanitizer. — The Hoffmans’ formal dining room has been converted to a bedroom for Miles.

Federal law promises children on Medicaid the equipment they need to thrive. Critics say routine delays and denials of medical equipment suggest KanCare does not live up to the law’s intent.

Disability Rights Center of Kansas executive director Rocky Nichols said the issue got worse when Kansas privatized Medicaid 10 years ago and handed over management to insurance companies.

“There’s been a lot more problems,” he said. “It’s a lot more difficult for people with disabilities or parents of kids with disabilities, to frankly get what they need under Medicaid.”

Kansas has three managed care organizations, known as MCOs, that operate KanCare.

Aetna, UnitedHealth and the Centene subsidiary Sunflower all received contracts with the state starting in 2019. Those contracts were automatically renewed last year for two years and won’t expire until the end of 2024.

“The managed care company gets paid upfront,” Nichols said. “So it creates a real problem.”

He said that cuts into incentives to insurers to cover more expenses.

Sheila Simmons operates a sort of stop-gap library of medical equipment in Parsons, Kansas. It checks out items including wheelchairs, crutches and beds.

Wheeled metal chairs made with metal tubing and other plastic parts are shown sitting on a carpeted floor. They are mobility devices for impaired children. — Some standing frames sit in the lobby area at the Assistive Technology for Kansas facility in Parsons. The location includes a variety of medical equipment able to borrowed as needed.

“The process is almost designed to be disheartening in some ways, if you ask a parent,” she said.

State negotiations

Advocates for those families want to make Medicaid work with fewer delays and denials.

Simmons, for instance, said more training for insurance companies on federal rules like EPSDT could help children access care they need.

“Kansas Medicaid needs to reassert that EPSDT is how they’re supposed to be operating,” she said. “And reminding (insurers) that if you’re able to document the child’s need — medically, physically — that equipment should be purchased.”

Alliance Rehab owner Scott Lopez finds himself regularly lobbying to get KanCare payments for equipment that doctors have prescribed.

“I’ve been trying to get a kid a bath chair since July,” Lopez said. “And we still don’t have that with them.”

That bath chair was finally delivered six months later. He said he has seen some progress.

“We’ve had some wins, we’ve had some kids get equipment that I didn’t think they’d get, it took a long time, we’re getting better at it, the state’s getting better at it,” he said. “But we just got to keep working to make it better.”

A woman leans over the back of a padded chair stroking the arm of a young girl sitting. She is covered with a blanket. Behind them a man is holding a coffee cup and looking on. — Dan and Kacy Seitz with their 12-year-old daughter, Hudsyn.

But the reimbursement through KanCare is still too little. If that doesn’t change, Lopez said, he is going to have to stop accepting Medicaid patients from Kansas.

With the current contracts to run KanCare ending next year, Nichols with the Disability Rights Center of Kansas, said the state can force insurance companies to deny less and pay for medical equipment more quickly.

“We don’t have the right incentives in the contract that the state controls to ensure that things are provided promptly,” said Nichols. “And the state needs to fix that.”

Other states, including Iowa, publish quarterly performance reports showing the rate of denials for each of the MCOs and what is being appealed the most by each insurer.

Frustrations

Dana Peterson is mom to a 20-year-old son, Charlie, with a chromosome abnormality. A few years back, she had to work to get a toilet adapter and wheelchair for him. They were custom-made, but the wrong sizes. So the family faces another long wait for the custom-made gear to be manufactured.

“It’s like starting all over again,” Peterson said. “If I have to pay out of pocket, I’m going to, because he needs something that works for him and that fits him.”

A temporary standing frame sits in the corner of Miles Hoffman’s room. His therapist, Grosdidier, has been able to loan it to the family until Miles gets his own personalized one. Neil Hoffman is grateful to have one, but he fears there will come a day when they lose it.

“I’m already pretty frustrated about it,” he said. “But I’d be pretty furious if we didn’t have one already.”

Samantha Horton reports on health for the Kansas News Service. You can follow her on Twitter @SamHorton5.

The Kansas News Service is a collaboration of KCUR, Kansas Public Radio, KMUW, and High Plains Public Radio focused on health, the social determinants of health and their connection to public policy.

Kansas News Service stories and photos may be republished by news media at no cost with proper attribution and a link to ksnewsservice.org.

March 25, 2023

Medicaid Unwinding in Kansas – Kansas Health Institute

Federal legislation tied to the nationwide COVID-19 public wellness crisis (PHE), initially declared on January 29, 2020, and renewed for 90 times a twelfth time on January 11, 2023, incentivized states to retain eligibility for Medicaid enrollees during the COVID-19 pandemic by growing federal funding for Medicaid applications. In response, the Condition of Kansas, and all other states, delayed motion on once-a-year reviews, ensuring constant Medicaid coverage for the duration of the pandemic. This policy has resulted in a file 536,222 individuals – 18.3 p.c of the Kansas inhabitants – enrolled in Medicaid and the Children’s Well being Insurance plan Plan (CHIP), collectively recognised as KanCare, as of December 2022.

The federal Consolidated Appropriations Act (CAA) 2023, handed in December 2022, decouples the federal funding for preserving Medicaid eligibility from the COVID-19 PHE. Current guidance from the Centers for Medicare and Medicaid Services (CMS) gives states up to 12 months starting up April 1, 2023, to initiate opinions to redetermine eligibility for all Medicaid enrollees. Kansas will be required to process all eligibility casework for KanCare (Kansas Medicaid) that was not acted on through the PHE. This course of action is identified as unwinding.

Some KanCare Enrollees are Anticipated to Shed Coverage Coverage

The ongoing protection requirement was put in area in March 2020. Just before then, 403,521 persons were enrolled in KanCare on average each thirty day period – 132,701 (24.7 p.c) less folks than have been enrolled in December 2022. As eligibility redeterminations resume, lots of of these Kansans might not be mindful of the prerequisites or could be unable to complete the specifications to sustain protection, or they may well no for a longer time be eligible for Medicaid coverage, and are at danger of turning into uninsured.

Some KanCare Enrollees are at Bigger Chance of Disenrollment

A lot of KanCare enrollees could be topic to churn – the temporary loss of Medicaid coverage in which enrollees are disenrolled and then re-enroll in just a short period of time. Lots of Medicaid enrollees knowledge repeated variations in profits or conditions which make them briefly ineligible for protection. Some also drop protection through the renewal system simply because they really don’t submit necessary paperwork in a well timed manner. Quite a few might practical experience limitations to enrollment, including administrative concerns (e.g., incomplete enrollment forms) and conversation boundaries. Particular Kansans could be at increased possibility of losing coverage during unwinding, like folks from racial and ethnic minority groups, especially Hispanic or Latino people, youthful older people, and folks with disabilities.

Exploration by the Assistant Secretary for Setting up and Analysis (ASPE) suggests that, across the country, kids and young older people, as properly as Latino and Black persons, will be disproportionately impacted through unwinding. They obtain that small children are far more likely to be afflicted by churn and younger grownups (age 18 to 34) are far more most likely to no longer be suitable.

In addition, ASPE uncovered that Latino individuals comprise around one-quarter of people predicted to be ineligible for Medicaid and about one particular-3rd of those predicted to knowledge churn, when Black men and women comprise 14 p.c of all those predicted to drop Medicaid eligibility and 15 per cent of those predicted to experience churn. People today with money among 138 p.c and 250 p.c of the federal poverty amount (FPL) comprised almost 40 p.c of people predicted to be ineligible for Medicaid, even though those with earnings fewer than 100 percent FPL comprise over fifty percent of those predicted to working experience churn.

Some KanCare Enrollees Live in Regions Wherever the Risk of Disenrollment is Increased

In 2022, the Local community Treatment Community of Kansas commissioned the Kansas Wellness Institute (KHI) to research Medicaid enrollment in the course of the pandemic and detect neighborhoods that may be most at possibility of disenrollment after annual assessments and eligibility redeterminations resume. Making use of enrollment facts offered by the Kansas Section of Health and fitness and Surroundings (KDHE), KHI determined neighborhoods exactly where KanCare enrollees may perhaps be at better threat of disenrollment at the time unwinding starts. Two requirements were employed to examine neighborhoods: 1) surplus development in coverage, and 2) churn.

New enrollees in neighborhoods in which KanCare enrollment grew much more speedily all through the pandemic than ahead of the pandemic are assumed to be at increased danger of disenrollment at the time unwinding starts.
New enrollees in neighborhoods that have professional bigger prices of churn, wherever individuals re-enrolled in Medicaid inside of just one year following staying disenrolled all through an eligibility redetermination, are assumed to be at a greater threat of remaining disenrolled after unwinding starts.

To decide places in Kansas with a bigger danger of disenrollment, KHI analyzed knowledge from February 2020 to June 2022. For the duration of that timeframe, there had been 97,977 new KanCare enrollees statewide, about fifty percent (53.3 {08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}) of them residing in neighborhoods at bigger threat of disenrollment. When enrollees across the point out will be influenced by unwinding, enrollees residing in these spots are more likely to be impacted. Figure 1 reveals the distribution by KDHE location of the enrollment boost and how a lot of of those new enrollees are at higher threat of disenrollment as soon as unwinding commences. Most new enrollees, like all those at higher hazard of disenrollment, are in Northeast Kansas and South Central Kansas, the most populous places of the point out. When much less in variety, there also was a significant improve in new enrollees in Southwest Kansas (28.1 per cent).

KHI also done this assessment at the county degree and identified that Sedgwick County experienced the most new enrollees, such as these who are at a better possibility of disenrollment. For the total evaluation, remember to see Improve in KanCare Enrollment by County, February 2020 – June 2022.

January 13, 2023

2023 Kansas Legislative Preview – Kansas Health Institute

Behavioral Wellness

Throughout the 2022 session, legislators talked over the need for extra mental wellness beds in the condition and included a proviso in 2022 HB 2510 to make an interim study committee on Sedgwick County regional psychological wellbeing bed enlargement that would present suggestions to the 2023 Legislature for thought. The Special Committee on Psychological Health and fitness Beds, charged with examining the need to have for inpatient psychiatric beds, developing a extensive-phrase plan to address mental health and fitness requirements, reviewing the regional mattress expansion plan, like how numerous beds would be made, examining very best practices for operation and oversight of the expanded beds, and examining the very long-phrase fiscal effects of more beds, met 5 periods involving August and December. Conferees provided associates from point out businesses, mental overall health advocacy companies, the Kansas Clinic Association, Kansas Association of Counties, regulation enforcement officers, Sedgwick County, Larned and Osawatomie point out hospitals, Kansas schools and universities, and psychological health providers. For the duration of the November 28 conference of the Particular Committee, the associates outlined their suggestions for the Legislature, which bundled:

Improvement of up to 50 condition institutional beds to be found in the Sedgwick County location in a site with place for growth
Initiation of this progress inside calendar 12 months 2023
Allocation of $40 million in funding from SPARK resources, as requested by Sedgwick County, for the obtain and renovation of a facility to property the beds
Approval of $15 million in state typical resources in fiscal calendar year (FY) 2023 to the Kansas Office for Growing old and Disability Products and services (KDADS) to be employed to commence the process for a ask for for proposal for the undertaking and
Approval of $5 million for each year to KDADS for FY 2024 and FY 2025 for a two-calendar year pilot plan to reimburse Kansas hospitals that deliver observation companies for people all through the interval prior to the availability of the new condition institutional beds, as requested by the Kansas Hospital Affiliation (KHA), including a prerequisite that KHA present at least yearly reporting to the Legislature regarding this reimbursement application.

Through the Special Committee’s final assembly on December 21, the customers focused on the issue of the behavioral health workforce in the condition and executed a roundtable dialogue on many subjects including:

Expanding the accessibility of entry-stage certifications for certified mental well being technicians (LMHTs) and psychological wellbeing developmental disability experts (MHDDTs), like whether recruiting for MHDDTs would be simpler if all or element of the coaching could be transferred towards yet another degree
Cutting down obstacles that stop retired behavioral well being specialists from returning to the workforce, together with issuing momentary licenses for those with expired licenses or those people who have not completed their demanded continuing schooling credits
Improving upon incentive courses for the behavioral wellbeing workforce, these types of as relocation bonuses, partnering with universities for recruitment, and featuring credit history toward other health care degrees for LMHTs
Improving the tracking and evaluation of incentive plans to ascertain if they are getting utilized and assembly their ambitions and
Taking methods to guarantee that Kansas behavioral wellbeing professionals’ wages are comparable to all those in other states and very similar professions.

David Fye, Government Director, Kansas Behavioral Sciences Regulatory Board, documented that the Board is contemplating alterations to its regulatory necessities for licensure reciprocity and also taking into consideration lowering the necessity for practicing in a particular space for a particular quantity of months and allowing pupils to full dependancy counseling, relationship and family members remedy, and social function programs on the web fairly than in-man or woman as at this time essential.

Committee associates also mentioned the importance of entry to remedy and scientific supervision for the behavioral health workforce and the need to have to handle significant individual-to-staff members ratios and the stressors faced by staff in the discipline. The Exclusive Committee will be publishing a report to the 2023 Legislature with their closing suggestions.

Clinical Marijuana

Legislation to make a regulatory framework for healthcare marijuana in the state will likely be on the table early in the session. The 2022 Distinctive Committee on Health care Cannabis, which was charged with finding out health-related cannabis regulation laws considered by the Legislature all through the 2021 and 2022 sessions – Property Substitute (H Sub) for Senate Monthly bill (SB) 158 and SB 560, respectively – and soliciting testimony from likely licensees, point out organizations, healthcare companies, and legislation enforcement officials, met four times through Oct and December. During the meetings, legislators heard each assistance for and opposition to the legalization of clinical marijuana from more than 60 conferees. For the duration of the Distinctive Committee’s meeting on Oct 19, customers also listened to from gurus from other condition clinical marijuana courses, who spoke about their successes and struggles when implementing their plans and recommendations for committee members to look at when crafting a invoice. Proponents of healthcare cannabis laws have pointed to the November 8 passage of a constitutional amendment in Missouri that legalized recreational marijuana as an incentive for Kansas to at the very least go health care marijuana.

November 19, 2022

Infographic: Health Insurance in Kansas 2021

Overall health insurance plan is deemed critical to entry large-quality health care and presents protection from extreme health-related charges. All through the 12 months, the Kansas Wellbeing Institute (KHI) provides in-depth facts about insurance coverage coverage in Kansas to enrich ongoing discussion of health and fitness coverage alternatives in Kansas and on the national stage. This infographic delivers our to start with glimpse of lately introduced detailed facts from the U.S. Census Bureau. Above the coming months, abide by us on Twitter, Fb or LinkedIn, and check out www.khi.org commonly to get a lot more facts as it gets obtainable.

This infographic provides a high-amount overview of insurance protection for 2,896,361 Kansans in 2021.

Highlights include:

Extra than 1.7 million Kansans ended up lined by private insurance, including:
- 1.5 million by employment-dependent protection,
- 58,269 by armed service or TRICARE insurance plan, and
- 176,594 by right ordered insurance plan, which includes 86,026 who ordered coverage on the Kansas marketplace made by the Very affordable Treatment Act (ACA).
A different 885,487 ended up covered by public insurance plan, like:
- 439,532 by Medicare,
- 359,253 by Medicaid or the Children’s Health Insurance plan Method (CHIP),
- 79,699 by each Medicare and Medicaid, and
- 7,003 by Veterans Affairs well being treatment.
And 266,114 Kansans had been uninsured, which include:
- 225,515 nonelderly adults, and
- 38,490 little ones.

Federal and condition insurance policies supported accessibility to health and fitness coverage coverage during the COVID-19 pandemic. Medicaid and CHIP enrollees were permitted to stay enrolled without redetermination, and subsidies to order a prepare on the ACA market ended up made extra generous and have been expanded to households with money above 400 p.c of the federal poverty stage (FPL $26,500 for a family members of four in 2021).

The American Rescue Plan Act of 2021 (ARPA) produced households above 400 p.c FPL newly suitable for a market subsidy in 2021 but the volume they been given depended on the benchmark program high quality and their domestic earnings. Households might have obtained $ if the high quality for their benchmark silver approach was a lot less than 8.5 per cent of their once-a-year cash flow – the productive utmost cash flow to get a subsidy.

Two-thirds (179,583 or 67.5 per cent) of uninsured Kansans in 2021 experienced domestic cash flow that would have capable them for subsidies to acquire health and fitness insurance policies on the Kansas marketplace. Amid those people who would have certified, 139,819 (77.9 {08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}) would have competent for subsidies to lower month-to-month rates below the first terms of the ACA and 39,764 (22.1 {08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}) would have freshly skilled for subsidies less than ARPA.

As of November 2022, Kansas is just one of 11 states that has not expanded Medicaid coverage to older people with residence income up to 138 percent of FPL, as authorized by the ACA. South Dakota grew to become the 39th condition to extend Medicaid soon after a ballot initiative passed on November 8. In 2021, Medicaid growth would have lined unique grownups with yearly household income up to $17,744 and grownups in a four-man or woman family members with annual household cash flow up to $36,570.

If the condition had expanded its Medicaid plan in 2021, 72,355 small-profits, uninsured Kansas grownups would have become newly suitable for Medicaid coverage.

Another 29,473 reduced-income uninsured Kansas older people and children had been probably now qualified for Medicaid or CHIP, but have been not enrolled

Be aware on details:
This infographic utilizes the most up-to-date-readily available knowledge, which arrive from the 2021 American Group Survey Community Use Microdata Sample from the U.S. Census Bureau and the Early 2022 and Full Yr 2021 Average Effectuated Enrollment Snapshot Report from the Centers for Medicare and Medicaid Providers. The Kansas populace offered is the non-institutionalized populace in Kansas. Estimates of the variety of Kansans qualified for Medicaid or qualifying for marketplace ideas and subsidies are centered on the Census Bureau definition of household units, which consist of all individuals currently residing in the sampled domestic, no matter of how users of the house are connected. True working experience may perhaps vary, as eligibility determinations for Medicaid and the well being insurance coverage marketplace involve other criteria.

This Infographic is component of our Annual Coverage Update series.