By Gail Parsons / Dec 19, 2022
Soon after the pandemic started shutting down offices and businesses the federal government declared a public health emergency, which put a temporary halt to the annual reenrollment for KanCare.
During the public health emergency, no state was allowed to end a person’s eligibility for Medicaid — that pause may come to an end in the next few months.
The public health emergency declaration is revisited every 90 days. The last renewal was in November, which extends it to Jan. 11.
“We don’t know when it will end,” said April Holman, executive director for the Alliance for a Healthy Kansas. “I’m hearing that it’ll be next spring sometime, possibly in March, but we don’t know for sure.”
In preparation, Holman said the alliance is working to get the word out to people that they need to ensure all their documentation is updated.
“There are a lot of things that could have happened that might make it difficult for people to realize they need to reenroll,” Holman said. “Particularly that the state has the most recent mailing address for participants in KanCare so, as these notices go out they are going to (get them). We are trying to … help people realize that they need to make sure their information is correct with their managed care organization, or with the state. And to make sure people realize … they will have to get back into submitting the information to verify that they are still eligible.”
Because Kansas legislators have yet to approve expanded for Medicaid, there will be people who will lose their eligibility for KanCare, she said.
“Right now, we have very limited criteria where an adult can qualify,” Holman said. “They have to A. have a child under the age of 19 at home and B. earn no less than 38 percent of the federal poverty line. If you are a childless adult, it doesn’t matter how little money you make, how low your income is, you don’t qualify.”
To meet the income threshold a household of one parent and two children cannot earn more than $8,750 a year according to the federal poverty guidelines.
“There really aren’t very many people who meet that criteria,” she said.
In November, South Dakota became the 39th state in the nation to expand Medicaid when voters approved a ballot initiative with 56 percent of the vote. Kansas is one of 11 states that has not expanded its Medicaid program. In not doing so, it has left trillions of dollars on the table.
“The federal funds that we have forfeited to date in Kansas is almost $6 trillion,” said Harold Courtois, chief executive officer at Memorial Health System, Abilene. “That money is going to other states.”
Courtois said some people wrongly believe expanding Medicaid will cause a financial burden on the state. However, KanCare will pay for itself.
The economic impact for Kansas in 2022, toward the last quarter of the year, would have been an additional $875,000 in commerce dollars; meaning the money that is paid by Medicaid and then rotated through the economy for such things as medication. For 2023 it is predicted at $2.1 million, and Medicaid spending would increase to $78 million, if the state has expanded KanCare, he said.
That is $78 million that would go to helping people get and stay healthy. When people don’t have access to health coverage, they don’t get the preventive healthcare they need, which ends up costing more in the long run.
“What happens on the back side is the care becomes much more expensive,” Courtois said. “People who don’t get the right medication end up on disability. Or maybe they have high blood pressure and don’t get (medication,) and have a stroke. Think about what it costs for us to take care of a person who has a stroke and becomes disabled for 10, 15, 20 years — it’s very expensive and it could have been prevented with Medicaid expansion and the right medications.”
While expanding Medicaid is a fiscally sound move, it’s not just about the money. It’s about doing the right thing, said Courtois, who describes himself as a right-wing conservative.
“There are good people out there who can’t afford healthcare and they need it,” he said. “And doggone it, we’re not doing that and I think it is important for us to provide that healthcare for everybody.”
Holman echoed Courtois’s view about the importance of helping people stay healthier, which in turn allows them to continue working. A healthier populace leads to fewer people on disability, and less stress on other safety nets, like welfare.
Another problem Holman sees is how the expanded Medicaid in neighboring states affects the health industry in Kansas.
“It is more and more difficult for providers in our border communities, particularly along the Missouri border and the Oklahoma border, to keep their qualified healthcare workforce,” she said. “There is a workforce shortage all over the country and providers in border communities are able to offer signing bonuses and higher wages to lure people across the border because they don’t have to deal with the same level of uncompensated care that our hospitals and clinics are dealing with in Kansas.”
Workforce shortages are especially difficult on small, rural communities, which have already struggled to stay afloat. According to a Dec. 2021 article posted at https://stackermedia.com/ Kansas is the seventh state with the most rural hospital closures since 2005. The article, citing data from the Center for Health Care Quality and Payment Reform, identified nine hospital closures from 2005 to 2021. Of the 105 rural hospitals in Kansas, 75 were running at a loss and vulnerable to closure.
“Having a full-service hospital is really important in being able to retain and attract new businesses to a community,” Holman said. “It is also important to the vitality to the community if people are able to get their healthcare needs taken care of at home and not have to drive a half-hour, 45 minutes to get healthcare.”
Holman and Courtois said they have and will continue to speak with state legislators about the importance of Medicaid expansion. Citing various polls, they said as much as 80 percent of Kansans support the expansion, but it is up to the legislators to act.
“We can’t do a referendum,” Courtois said. “It has to be done by the legislators, the people can’t vote on it unless we change the constitution. Eight out of 10 people in Kansas believe we should have Medicaid expansion. Why aren’t we be represented in Topeka by the voice of the people? They are not listening – they think they know more than we do, they don’t and that’s an issue.”
From his perspective, it is a matter of educating local legislators, like Scott Hill, the newly elected representative for the 70th district.
Hill said he still has research to do on the topic before he can put his support behind or in opposition to it expansion.
“I really am not educated enough yet,” Hill said. “I’ve heard their side of the positives of Medicaid expansion but I really haven’t talked to people on the other side of that issue to know why it hasn’t happened in the past.”
Besides the idea that Medicaid expansion will cost Kansans money, a notion that Courtois said is not factual, some opponents have voiced concern about how it will affect people on disability, Holman said.
“We hear people say that they don’t support expansion because it would hurt individuals with disabilities and put them at the end of a line for services, that is not true,” she said. “Actually, all of the groups in Kansas that represent people with disabilities, support expansion.”
One reason those groups are supportive is because upwards of 75 percent of people who have a disability in Kansas do not have a federal disability determination through Social Security, so they struggle if they are in the coverage gap.
She and Courtois hope to see movement in the 2023 legislative session, which starts Jan. 9. There has not been a hearing on expansion in the Kansas Legislature since 2020, when representatives came to a bi-partisan compromise, Holman said.
“But the pandemic hit and things got shut down before that bill was able to make its way through the process,” she said. “There is a disconnect between the will of the people and what’s happening at the Kansas State House. Gov. Kelly has long been a supporter of expansion but the conservative leadership at the statehouse has been in opposition and they have been pretty successful in keeping legislation from moving through the regular channels.”
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