22 August 2023 | Health

Far Too Many Kids Continue to Lose KanCare Coverage for Paperwork Reasons

Heather Braum | August 22, 2023

The state released the third set of data for the KanCare unwinding process. As we previously said in June and July, we continue to be 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. At an early August meeting of the legislative KanCare Oversight Committee, the state announced several changes that they have implemented, some of which we advocated for.

Kansas kids remain at a significantly higher risk of losing their KanCare coverage during this process, even if they remain eligible for coverage. 

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

  • 283,709 individuals sent a KanCare renewal letter 
  • 69,876 individuals renewed (including 49,123 in “family medical”)
  • 17,915 individuals (including 14,985 in “family medical”) determined ineligible and their KanCare coverage was discontinued  
  • 60,935 individuals (including 54,496 in “family medical”) had KanCare coverage discontinued for procedural reasons but can re-enroll within the 90-day window review period
    • 61.9 percent of those in the 90-day window are children 

What the Data Means and Lingering Questions 

The state is now releasing data by age and county for the renewed, ineligible, and 90-day window categories, located on each category’s page. This breakdown gives us a more detailed picture of how the unwinding is going for children. The statistics continue to not be great news: 61.9 percent of those in the 90-day window who have yet to return a renewal form are children. This is only a slight decline from the data posted back on July 25, when we calculated that kids were 62.3 percent of this category.  

Particularly, more than two-thirds of those in the 90-day window are children in the counties of Chautauqua, Clark, Decatur, Finney, Ford, Gray, Greeley, Hamilton, Jewell, Rawlins, Seward, Smith, Stanton, Stevens, and Wyandotte. Many of these counties are in Southwest Kansas. 

Additionally, many of those in this 90-day window category (who had their coverage discontinued back on May 1) are now no longer in that 90-day window, as it has now ended. Those who never returned a form to the state for any number of reasons will now have to re-apply for KanCare and see if they remain eligible for the program.

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.

Between the second and third data releases, we saw a significant jump in the number of renewals completed (29,012 through June 30 versus 69,876 through July 31). However, there is still a significant gap between the different categories and the total number of renewal notices sent out.

It appears fewer renewal notices were sent out in July, as the increase in the total number of notices sent out only increased by 8,062 (total was 275,647 letters sent through June 30 versus 283,709 through July 31).

Pending reviews (those who have sent back a renewal form 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 the Center for Medicare and Medicaid Services (CMS) through a monthly report.  

There continue to be 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. We continue to watch this data closely, especially in light of the troublesome history with previous call center vendors.  

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. These include: 

  • The number of pending reviews, or information that was turned in but hasn’t been reviewed yet. This could tell us if the state and the contracted call center fall behind on review processes, indicating if more staff should be hired or processes should be further streamlined. 
  • The percentage of reviews happening through automatic processes (ex parte reviews) or pre-populated forms. This could eliminate some of the red tape and administrative burdens that families face. 

While not required to be reported to CMS, it would also be helpful to know more details of the reasons for why enrollees fall into the 90-day window. This would help advocates understand the different reasons for procedural disenrollments and direct targeted outreach, shift messaging, or change state policies. 

Finally, as some leave the 90-day window category due to deadlines passing, 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 is not (so far) releasing data for why enrollees fall into the 90-day window category, this is the only data number we have to 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 coming months. Will we see a large increase, indicating many of these former enrollees who lost coverage for paperwork reasons, may be re-applying for coverage, because they are still eligible? Time will tell.

State Updates KanCare Oversight Committee on Unwinding Progress; CMS Warns Kansas

In early August, the state provided updates to the legislative KanCare Oversight Committee focusing on lessons learned and changed policies as the renewal process has unfolded.

One of the updates included that, because of postal service delays, renewal notices will now have longer response times before coverage is discontinued. Enrollees should still always try to return their renewal form by the listed due date, but for now, not returning the renewal by the due date will not be grounds for immediate coverage discontinuance. That is a step in the right direction, as the state also indicated this longer response time has led to more forms being returned and some paperwork hiccups (like unsigned forms) to be resolved.

The state has also received a few more flexibility approvals from CMS, including that MCOs are now authorized to help with some of the renewal process.

Finally, the state received a warning letter from CMS, focusing on the concerning call center numbers through May. Those numbers have since improved.

Continued Outreach Needed — Especially in Schools

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

After three data releases, it continues to be obvious that more KanCare members must be reached, particularly families. Research has shown many Medicaid and CHIP beneficiaries are unaware of the ongoing renewal processes.

We continue to ask all Kansans — including community, education, religious, and health organizations; businesses; public officials; and the media — to continue ongoing outreach to 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.

To help with messaging at back-to-school events, CMS has created a toolkit targeted at parents. Cover Kansas is also willing to provide materials or staff a table at events. 

The state has provided Kansas-specific toolkits on their website (English; Spanish; other resources) for messaging options; additional messaging tools are available through CMS. Join the Kansas Medicaid Renewal Helper network to participate in monthly calls and receive important updates.  

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?

We’re encouraged to see the state adjust policies and disaggregate some of the data so we and other advocates can analyze how kids are faring during this complicated renewal period. Seeing that a large majority of those in the 90-day window (who didn’t return a renewal form) are children only reiterates the need for continued outreach to Kansas families.  

As the renewal process continues over the next several months, we will monitor and analyze these data releases, advocate for the state to change directions where it can, and continue to work with partner organizations and the public to reach families with KanCare coverage to ensure everyone who is still eligible keeps their coverage.

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