01 November 2023 | Health

Slight Improvements, but Too Many Kids Continue to Lose KanCare Coverage

Heather Braum | November 1, 2023

We are more than seven months into the KanCare unwinding process and have the latest data available through September 30, 2023. As we previously shared in June, July, August, and in early October, we remain alarmed that far too many children are losing coverage because their renewal forms aren’t successfully returned, received, or other paperwork glitches are occurring – not because they no longer meet income eligibility guidelines. The state continues to work on reinstating coverage to thousands of Kansas kids after they lost coverage due to a systems glitch.  

Data breakdown, reported as of September 30, 2023, since the start of the unwinding process: 

  • 337,079 individuals sent a KanCare renewal letter
  • 122,174 individuals renewed (including 77,735 in “family medical”)
  • 26,362 individuals (including 22,116 in “family medical”) determined ineligible and their KanCare coverage was discontinued  
  • 55,912 individuals (including 50,099 in “family medical”) had KanCare coverage discontinued for procedural reasons but can re-enroll within the reinstatement window review period 
    • 59.6 percent of those in the reinstatement window are children 

Note: In the recent data releases, the state switched from using “90-day window” to “reinstatement window” for procedural reasons.

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 are slightly improving but continue to not be great news: 59.6 percent of those in the reinstatement window who have yet to return a renewal form are children.

Children in Ellsworth, Ford, Gray, Hamilton, Jewell, Rawlins, Seward, Smith, Stanton, and Stevens counties make up more than two-thirds of those in the reinstatement window in those counties. Most of the counties are clustered in Southwest Kansas. This is fewer counties than in our previous reports. However, it’s still 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.

Of all child age breakouts, the 13-18 age group (11,694) continues to account for a higher rate of procedural disenrollments. There are many reasons why this could be occurring, but anyone who works with teenagers likely to have KanCare coverage should be aware.

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

Almost 150,000 KanCare members, including 85,163 children, have had their renewal process completed and determined to be eligible or ineligible for coverage based on redetermination criteria.

The number of 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 the federal Centers for Medicare and Medicaid Services (CMS) through a monthly report. 

There are significant month-to-month improvements in the call center numbers, indicating that the state 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 their unwinding data. 

Changing Timelines and Policies

At the halfway point in the unwinding process, the state’s timelines and policies look different compared to when the state began redetermining eligibility for KanCare members in April. All changes have been implemented to overcome numerous administrative barriers and situations outside members’ control, as well as responding to CMS directives and guidelines.

Generally, the state sends renewal forms to KanCare members one month before their renewal due date when more information is needed to determine eligibility than what the state has access to. When the state had access to enough information about a member to renew coverage, their coverage was renewed passively (called an “ex parte” renewal).

Initially, members had to return their renewal form by the 15th of their renewal month or lose coverage, but beginning with the May group, that due date was backed up several months after postal delays and other administrative issues were uncovered early in the process. Since May, members are still strongly recommended to return their form by the 15th of their renewal month. If forms aren’t returned by the 15th of the due date month, the longer period before coverage is discontinued due to an unreturned form gives advocates, providers, and managed care companies additional time for outreach.

Also, a report is normally scheduled to run by the state mid-month to discontinue coverage on the first of the next month for those who didn’t return a signed renewal form on time (some refer to this as “procedural disenrollments”). However, throughout these past seven months, the state has only run the report three times (April, July, and October) due to numerous pauses to change internal processes and to sort out the systems glitch.

The state sent out renewal notices in March, April, May, June, August, September, and October for those with renewal dates in April, May, June, July, September, October, and November. Those with August due dates were moved to months at the end of the unwinding period, so the state could use August as a catch-up month.

Here’s a few specifics of how disenrollment timelines changed since the beginning of the unwinding, based on the April, May, and June due date groups.

  • April due date group: The state ran discontinuances in mid-April for the April due date group, and coverage was discontinued May 1. However, the state had to reinstate coverage for many of these members in May due to postal system delays and other uncovered issues. Additional members in the April due date group will have coverage reinstated shortly due to the previously described systems glitch. Most of these will be children.

  • May due date group: The state ran discontinuances for this group in mid-July, and coverage was discontinued on August 1. Additional members in the May due date group will also have coverage reinstated shortly due to the previously described systems glitch. Again, most of these will be children.

  • June due date group: The state ran discontinuances for this group in mid-October, and coverage will be discontinued on November 1. An extra process was run in this report to catch those who should have been renewed automatically, addressing the systems glitch.

  • July and later due date groups: Next steps and timeline are yet to be determined.

Continued Outreach Needed

Insurance coverage plays an important role in covering doctors appointments, vaccinations, time-sensitive treatments, and therapies for kids. Yet it is now painfully clear that 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?

As the unwinding process marches along, 73,504 Kansas kids have had their KanCare coverage renewed; 11,659 of Kansas kids have been determined to be no longer eligible for coverage; and 33,323 of Kansas kids have had their coverage discontinued because paperwork didn’t make it back to the state in time, but they still can get their renewal form submitted without needing to reapply for coverage.

Too many kids are losing coverage in this unwinding process who should be keeping it, showing there are longstanding issues with how the renewal process works. The unwinding has exposed many issues in our eligibility system that need to be fixed. Kansas has changed some things in response to advocate feedback, but there is always room for improvement.

It is unacceptable that it should be this hard to access coverage, especially for children. This unwinding process has shown there is much work the state must do to ensure every eligible child can get — and keep — the health care coverage they need to grow up healthy.

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