As Unwinding Continues, Thousands of Kansas Kids Lost Coverage Due to Systems “Glitch”

Heather Braum | October 12, 2023

As reported in late September, thousands of Kansas kids lost their KanCare coverage due to a systems “glitch.” Additionally, according to data available through August 31, 2023, almost 36,000 children lost their coverage due to procedural reasons – not because they no longer met income eligibility guidelines.

As we previously shared in June, July, and August, we remain alarmed that far too many children are losing coverage because their renewal forms aren’t successfully returned or received, or other paperwork glitches are occurring.  

Data breakdown, reported as of August 31, 2023, since the start of the unwinding process:  

• 300,543 individuals sent a KanCare renewal letter  
• 99,491 individuals renewed (including 65,947 in “family medical”) 
• 22,474 individuals (including 18,797 in “family medical”) determined ineligible and their KanCare coverage was discontinued   
• 58,178 individuals (including 52,614 in “family medical”) had KanCare coverage discontinued for procedural reasons but can re-enroll within the reinstatement window review period  
  • 60.9 percent of those in the reinstatement window are children  

(Note: In the latest data release, the state switched from using “90-day window” to “reinstatement window” to describe those who have lost coverage for procedural reasons.)  

The Systems "Glitch" 

A newly discovered systems “glitch” has caused thousands of Kansas children to lose their coverage in error.

As part of the renewal process, the state’s Medicaid agency utilizes electronic data matches with reliable sources of data before sending enrollees a renewal form or requiring them to submit documentation.

Known as “ex parte,” this process results in coverage being automatically renewed for those whose eligibility depends on income only and if their income is below certain eligibility thresholds. As children have much higher income eligibility thresholds than adults, many children should be expected to be automatically renewed.

Renewals are supposed to be processed at the individual – not household – level. However, dozens of states had this process set up incorrectly, where the “ex parte” renewal was done at the household level, not the individual. If just one person was above the income threshold for their eligibility category, everyone in the household was sent a renewal form. If forms were not returned in time, coverage was discontinued, even for those whose family income automatically returned as keeping them eligible for KanCare.

The Centers for Medicare and Medicaid Services (CMS) sent a letter to all states on August 30 requesting states investigate their systems and processes and report back by September 13. On September 21, CMS revealed that Kansas was one of the states impacted. Media reports indicated that up to 12,000 Kansans – adults and children – are caught up in this situation, but it turns out that all but 121 of this impacted group are children, based on a State report to the Bob Bethell KanCare Oversight Committee in October.

It is good that CMS has uncovered the glitch; the state has short- and long-term fixes in place or in process of implementation; and the state will re-instate coverage for impacted individuals in the next couple of months. However, we remain concerned that numerous other issues – outside the control of parents and caretakers of children – are causing too many Kansas kids to lose their KanCare coverage.

What the Data Means and Lingering Questions 

The state continues to break out data by age and county for the renewed, ineligible, and reinstatement window categories. This breakdown gives us a more detailed picture of how the unwinding is going for children and allows for local advocates to do more targeted outreach. The statistics continue to not be great news: 60.9 percent of those in the reinstatement window who have yet to return a renewal form are children.

More than two-thirds of those in the reinstatement window are children in the counties of Ellsworth, Finney, Ford, Gray, Greeley, Harper, Jewell, Rawlins, Republic, Seward, Smith, Stanton, and Stevens counties, mostly clustered in southwest and north central Kansas. That’s fewer counties than in our previous report (15). However, that’s not cause for celebration, as almost all Kansas counties continue to see percentages above 50 percent for children who lost their coverage for procedural reasons; only Elk, Osborne, and Trego counties are below 50 percent.

When looking at the age breakouts, the 13-18 age group (12,425) accounts for a higher rate of procedural disenrollments compared to the other child age breakouts. There are many reasons why this could be occurring, but anyone who works with teenagers likely to have KanCare coverage should be aware.

Additionally, these numbers do not account for those who had their coverage discontinued back on May 1 for procedural reasons, as they are now outside the reinstatement window period. Those who never returned a form to the state for any number of reasons now must re-apply for KanCare and see if they remain eligible for the program. We hope that this group will be re-accounted for in future data releases.

It will cost the state additional money to re-enroll these kids. Paperwork barriers — many outside members’ control — must be reduced in the future and should not be the cause for children losing their health insurance coverage. Policy solutions like implementing multi-year continuous eligibility for young children is one possibility.

Pending reviews (renewal forms that have been returned but haven’t been processed yet) continue to not be publicly reported by Kansas, even though the state is submitting this required data point to CMS through a monthly report.  

There continue to be significant month-to-month improvements in the call center numbers, indicating that the center remains responsive to customer service demands. Time matters for many KanCare members, as sitting on a phone indefinitely may mean running out of minutes on a cell phone plan or abandoning a call because a breaktime ends at work.

How does Kansas compare to other states? Check out the KFF unwinding tracker and the Georgetown Center for Children and Families tracker for comparisons as more states continue to publicly release or update their unwinding data.

Missing Data

We have raised these issues in previous months’ data breakdowns, but when looking at other states’ unwinding data, Kansas continues to be missing several key data points, many of which were submitted in a mandatory report to the federal government but were not posted publicly to the state’s unwinding website. This includes the number of pending reviews and the percentage of “ex parte” reviews.

Also, as we’ve previously shared, it would be helpful to know more details of the reasons for why enrollees fall into the reinstatement window. However, when advocates asked for this information, we learned that the state’s IT systems for KanCare don’t appear to currently store these details or it’s impossible to currently obtain through reporting. In fact, several situations have arisen over the last several months that keep pointing back to woefully outdated information systems. This unwinding process reveals several needs to improve the data systems and processes that are behind the state’s KanCare program.

As some leave the reinstatement window category due to deadlines passing, how and where will they be accounted for in future data releases? That is an additional number that has not been previously tracked, but we hope it will be in future releases. As the state has not been able to release why enrollees fall into the reinstatement window category, the total number of people falling into the reinstatement window is the only way we can track how many are losing coverage due to paperwork reasons. It will be important to compare this number to the number of new applications for KanCare coverage in the coming months.

Continued Outreach Needed

Insurance coverage plays an important role in covering doctor’s appointments, vaccinations, and time-sensitive treatments and therapies for kids. Yet it is now painfully clear: thousands of Kansas kids may no longer have access to medical care because they have had their KanCare coverage discontinued due to paperwork reasons.

We continue to ask all Kansans — including community, education, religious, and health organizations; businesses; public officials; and the media — to reach KanCare members across the state about the ongoing renewal process so eligible Kansans — especially children — keep their coverage. Organizations that work with children in schools, early childhood settings, and after-school settings are particularly important in these efforts.

Review this national call to action to discover specific steps for enrollees to take. In general, KanCare enrollees must:  

• Keep their contact information updated with the state. 
• Watch their mail for renewal mailings from the state. 
• Return signed forms as soon as possible (even if only partially completed). 
• Watch for and quickly respond to follow-up communications.  

Even if parents/caretakers are no longer eligible for KanCare, their children may remain eligible due to higher income limits, so parents must send back the renewal form.

What's Next?

While we are troubled by the uncovering of a systems “glitch” with the “ex parte” process and that an ongoing high number of kids are losing coverage due to procedural reasons, we are encouraged that the state is taking steps to address the glitch, pause disenrollments for procedural reasons, and continue to work with organizations for ongoing outreach to KanCare members.

The state will release more data later this month, and we hope to see improved renewal and reinstatement numbers so that everyone who is still eligible can keep their KanCare coverage.

 

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