TOPEKA — On June 8, Gov. Sam Brownback delivered an upbeat assessment of the state’s Medicaid program.
KanCare had faced difficulties as program administration shifted from the Kansas Department of Aging and Disability Services to the Kansas Department of Health and Environment, he acknowledged. The Medicaid program still had a backlog of unprocessed applications, but the figure had been shrinking in recent weeks.
“Overall, KanCare has been a very successful program. Not that there haven’t been disputes and different things along the way, and we’ve had some sign-up difficulties as we’ve shifted it from KDADS to Department of Health and Environment — but we’re getting on top of those, and that’s starting to work,” Brownback said.
Two days later, the state sent a letter to the federal government. The backlog, as it turned out, was actually four times as large as previously thought.
The state knew about a week before the June 10 letter, which later leaked to media, that the backlog had been under-counted, but re-ran the figures to verify.
The disclosure late last week that Kansas had under-counted the number of unprocessed applications by 12,000 is drawing fresh attention to the state’s new electronic eligibility system nearly a year into its troubled rollout. The apparent progress the state had been making toward whittling down the backlog now is thrown in doubt.
Data from the state show the backlog grew the most among those waiting 45 days or more with unprocessed applications. The error leading to the low-ball figures — made by the contractor Accenture, the state said — excluded those reapplying for KanCare.
Accenture — which brands itself as a global consulting, technology services and outsourcing company — has numerous government contracts and has faced trouble in some states. Kansas says a reporting problem made by the company, tasked with implementing the eligibility system, produced the under-counting and not the eligibility system itself.
Kansas said Monday it will withhold a $750,000 payment from the company in response.
Lawmakers once again are seeking answers and expressing frustration with KanCare, bedeviled by a backlog for months and complaints of problems accessing the program. Official legislative inquiry likely will have to wait until August, however. House and Senate leadership have ruled out hearings during the upcoming special session.
“We’ve got to figure this out. This is getting pretty bad,” said Rep. Dan Hawkins, a Wichita Republican who chairs the KanCare Oversight Committee.
Kansas has experienced problems with Medicaid since bringing its electronic eligibility system, known as KEES, online last year. The issues contributed to the formation of a backlog in unprocessed applications.
The backlog has been well-publicized in recent months as patients and advocates for the elderly and disabled report problems accessing the program. In response, the state brought on temporary staff to combat the backlog.
Figures showed the backlog declining. From 18,216 at the start of February, the number of unprocessed applications fell steadily through the beginning of May. At that point, the state reported just 3,480 applications awaiting action.
Then came the letter.
KDHE Secretary Susan Mosier wrote to the federal Centers for Medicare and Medicaid Services on June 10. In her letter, she disclosed the state previously had underreported the backlog.
The letter was one in a series of bi-weekly reports from the agency to the federal government, which asked Kansas for regular reports on the backlog beginning in February. Mosier explained the change in the backlog number stemmed from an error made in the method the contractor — Accenture, the state confirmed Monday — used to create the earlier reports.
Multiple Accenture spokespeople didn’t respond to emailed requests for comment.
The original backlog reports only counted applicants when an eligibility determination had not yet been made, wrote Mosier. The actual backlog, she explained, also includes individuals who had received an eligibility determination in the past but who have reapplied and still are awaiting action on their new application.
The error in the earlier reports had been “investigated and reviewed,” Mosier wrote.
Angela de Rocha, spokeswoman for KDADS, said the problem was tied to the state’s operating reports, not to a problem with the KEES system.
The system actually allowed the problem to be spotted, she said.
“Eligibility staff who were working individual cases noticed that the reapplications they were working on were not reflected in the system, or were reflected as ‘completed.’ They alerted management to the ‘missing’ cases,” de Rocha said.
The error was discovered about a week before the letter was sent, de Rocha said. She added the numbers had to be run again to verify.
“You can imagine the dismay,” de Rocha said.
The adjustment to the backlog was sweeping. The total number in the backlog rose from 3,480 to 15,393.
The backlog is broken into timeframes. Although all categories increased sharply, the number of applications awaiting processing for more than 45 days jumped the most, more than quintupling from 2,081 to 10,961.
Under Medicaid, states generally are required to determine eligibility within 45 days on all cases, except disability.
Numerous states have experienced computer problems and worked through them, but under the law a state cannot delay providing an eligibility determination because of administrative problems, said Elizabeth Edwards, an attorney with the National Health Law Program. The organization advocates and litigates on behalf of patients throughout the country.
Reports of backlogs popped up around the country a few years ago, Edwards said, as several states sought to use funds available under the Affordable Care Act to revamp their Medicaid administrative functions.
“A lot of states seized that opportunity to update systems that a lot of times were from the ’80s,” Edwards said.
North Carolina battled its own food stamp processing backlog in 2014 under its eligibility system, known as NC Fast. That system also was developed by Accenture.
The federal government chided a number of states in 2014 for Medicaid backlogs, targeting Alaska, California, Michigan, Missouri, Tennessee and Kansas.
“It’s been sort of an issue across the country, but it depends on the state on how they’re resolving the problem,” Edwards said.
Price to pay
Accenture will pay a price for undercounting the backlog, the state said. According to de Rocha, the KDADS spokeswoman, the state will withhold a $750,000 payment.
The total value of the company’s contract, which runs through 2021, is $264 million.
Secretary Mosier, in her June 10 letter, said in response to the revelation of a bigger-than-thought backlog that the state had moved to retain all of the temporary staff that were scheduled to be released at the end of the month.
According to KDHE’s first status update to the federal government in March, KDHE and Accenture added 20 temporary full-time eligibility staff. Those staff will now stay on.
Sen. Laura Kelly, D-Topeka, said the state still bears the primary responsibility.
“When you outsource something, when you contract something, it’s your responsibility to make sure the job is getting done,” Kelly said.
Hawkins, the Wichita Republican, said he is seeking additional information from KDHE and KDADS.
“It surely is disappointing, and I’m getting calls from constituents that are having problems,” Hawkins said.
He indicated he also wants to know more about the Medicaid cuts announced by Brownback in May. Brownback cut Medicaid provider reimbursement rates by 4 percent as part of budget-balancing measures. The cut itself saves the state approximately $38 million, but will cost providers much more because they also lose the matching federal dollars.
Hawkins said he had approached legislative leadership a few weeks ago about the possibility of holding hearings during the special session, which begins Thursday, and was told no. Spokeswomen for both House Speaker Ray Merrick and Senate President Susan Wagle said Monday they want the session focused narrowly on school finance.
The KanCare Oversight Committee is set to meet in early August. Hawkins said he wants much of the meeting focused on the Medicaid cut and the ongoing backlog.
The state hopes the backlog will have shrunk significantly by then.
“Despite this setback, the state believes its eligibility determination backlog issues will have been dealt with by the end of summer,” de Rocha said.