red tape and income limits have booted 82,000 kansans off medicaid since may. how can they get back on?

sawyer belair | kansas city beacon

October 24, 2023

Robyn Adams struggled to support her husband and teenage daughter on $16,000 a year during the pandemic.

Then the pandemic ended and her family lost its Medicaid coverage.

“We went into panic,” she said.

The family relied on a temporary expansion of coverage authorized by the federal government during the pandemic to weather the bills that came with her rheumatoid arthritis, her husband’s heart condition and her daughter’s Type 1 diabetes. 

Suddenly, the family faced a cost of prescription drugs that runs thousands of dollars a month. Although her daughter remained covered, the pay Adams brought in working at Walmart in Newton, Kansas, didn’t stretch that far.

She’s among 82,000 Kansans who have lost Medicaid coverage in the first six months since the end of the national COVID-19 emergency, during an ongoing period of shrinking eligibility to pre-pandemic rules referred to as the “Medicaid unwinding.” Some lost their coverage because they earn too much money to qualify — including Adams’ family.

Massive consequences for missing information

Others have been bounced from the rolls because of the state’s bungling of its own red tape.

Keeping or losing your government health insurance can come down to a misplaced signature, whether the state has your current address or other misfiled paperwork. Each month, as their enrollment goes under review, more Kansas families find themselves without Medicaid coverage. 

In addition to being one of 10 states that did not expand Medicaid eligibility under the Affordable Care Act, Kansas has terminated 50% of its renewal cases since May due to bureaucratic issues rather than whether the recipients qualify. 

Research from the Kaiser Family Foundation found that such terminations made up the vast  majority of people who lost their coverage from KanCare — the state’s privatized Medicaid program — since May.

Matthew Lara, a spokesperson for the Kansas Department of Health and Environment, which oversees KanCare, said “procedural reasons” can refer to a failure to turn in paperwork, to verify income or to supply an accurate address. He said the state tries to confirm an address at least three times.

Among such cases, Kansas now has the second highest termination rate in the country. Robyn Adams, a grocery vendor from Newton, Kansas, is one of 82,000 Kansans who lost Medicaid benefits during the nationwide post-pandemic contraction – known as the “unwinding” – about twice the national average of 28%.

Lara also said that some who lose coverage because of those paperwork issues may also not qualify for income reasons. But he said the state doesn’t know how many people would fall into that category.

In addition, a glitch in the state’s auditing process discovered in late August caused some 12,000 Kansans to lose coverage despite meeting eligibility requirements. That prompted a temporary pause in the KanCare unwinding.

Lara said just under 10,000 Kansans, nearly all children, are still in line for reinstatement as the office works on resolving the error.

About 40% of people on KanCare have yet to have their enrollment reviewed. But the state appears on pace to boot about 137,000 people from Medicaid by the time it’s looked at all of the cases. That’s about a fourth of people on KanCare during the pandemic.

How to know if you still qualify for medicaid coverage

About two-thirds of the people who lost their KanCare coverage can still appeal. Depending on their cases, they have from 90 days to eight months to challenge their loss of benefits.

Lara said the renewal process can be completed through one of three methods:

  • Complete, sign and mail or fax the renewal form to KanCare.
  • Complete the renewal online or submit an online application.
  • Call the clearinghouse (at 800-792-4884) to discuss other options if the member needs additional submission options.

For those who already meet the guidelines for Medicaid, Lara said no further action is needed. 

KanCare is restricted to people in households that fall below an income threshold. For Kansans like Adams, a parent with a dependent child in a three-person household, that income level is 33% of the federal poverty level, or roughly $8,200 per year

In addition, the program is limited to refugees during their first eight months in the United States, people with disabilities, adults over 65, pregnant women and children under 19 along with their parents. 

That leaves a gap for 44,000 people in the state who make too much money to qualify for Medicaid — and too little money to qualify for Affordable Care Act-subsidized health insurance.

What about those who don’t qualify?

Adams’ daughter kept her Medicaid coverage. But Adams didn’t. She said she needs Humira to cope with arthritis or she wouldn’t be able to work. That costs $1,500 a month and is just one of eight prescriptions she takes. Ultimately, she got the drugs covered by a free program through a Newton-based clinic.

“We were really lucky,” Adams said. “I don’t know what we would’ve done (without it).”

For those who fall into the coverage gap, Lara advised going online or calling 866-826-8375 to look for other affordable insurance plans. 

Democrats, social service advocates and some business groups say Kansas needs to expand Medicaid to bridge the gap for people who don’t qualify for either KanCare or the Affordable Care Act insurance marketplace. That would require the state to foot 10% of the bill at a cost of about $57 million a year. 

That estimate came from Democratic Gov. Laura Kelly’s budget department. It also projected lower administrative costs and an infusion of federal tax dollars to the Kansas economy saving taxpayers about $70 million a year.

Medicaid expansion would add coverage for more people, over 15,000, in Sedgwick County than any other county in the state — almost three times the increase that would be seen in the more populous Johnson County. 

The past, present and future of expanding medicaid coverage

But Medicaid expansion has run into stiff opposition in the Statehouse. First, Republican then-Gov. Sam Brownback in 2017 opposed the ACA, also known as Obamacare. Then Kelly, a state senator at the time, was elected in 2019 on a campaign to expand Medicaid. But Republican leaders in the Legislature blocked the legislation despite tenuous support from rank-and-file lawmakers.

“We don’t want to take on something that we know is absolutely unaffordable and will require a tax increase,” said then-Senate President Susan Wagle, a Wichita Republican, in 2018.

In addition to objections to the upfront cost of the program, Republican leaders have expressed concerns about its cultural impacts. 

“Medicaid expansion, they think it’s a panacea, but it’s not,” said Senate President Ty Masterson during a September press conference. He also called Kelly’s advocacy campaign a “welfare” tour for “able-bodied adults (who) choose not to work.” 

Many expansion advocates challenge that characterization, however.

“That really harkens back to a very outdated model,” said April Holman, the executive director of the Alliance for a Healthy Kansas — a group formed to lobby for Medicaid expansion. “I think now, it is not a given at all that people receive insurance, even the opportunity to buy into insurance, through their work.”

The Kansas Health Institute estimates that just over half of Kansans get insurance through an employer.

Members of the state Senate and House committees on public health didn’t respond to requests for comment on their views toward expansion.

The governor, meantime, argues expansion is still politically possible.

“Trust me when I tell you that there are many Republican legislators who are just as frustrated as I am that we are unable to get this done,” Kelly said at a Pittsburg, Kansas, hospital earlier this month.

She said voters want expansion and cited a late 2021 survey by Alliance for a Healthy Kansas that found support among 78% of respondents. Another survey by Fort Hays State University in late 2022 found that 72% of respondents supported expansion.

Expansion has happened in some Republican-dominated states after citizen petitions put the issue up for statewide votes in Oklahoma, Missouri and Nebraska. But in Kansas, only lawmakers can put a referendum on the ballot.

‘the people who really need it’

Meanwhile, onetime Medicaid recipients like Robyn Adams look for other ways to pay for medical care. While she could not afford the $100-$200 per month plans KanCare initially directed her toward, Adams was ultimately referred to Ambetter health insurance, which provides coverage to some people who don’t qualify for Medicaid. It has received poor ratings from many customers.

When she wasn’t so encumbered by health issues and had a more lucrative job, Adams said, she was oblivious to struggles of living without health insurance.

“You don’t think about it as much when you’re middle class or better,” she said. “But the people who really need it, they see it, they feel it.”

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