Few paper applications, long call wait times seen as barriers to applying for Medicaid in Kansas

The paper message taped to the glass entrance of the Department for Children and Families' downtown Topeka service center is short.

In English and Spanish, the sign tells readers the agency no longer administers the state's Medicaid program for long-term care nor for the elderly and disabled -- and it directs individuals to contact the new administrator, the Department of Health and Environment.

But the sign has no contact information for KDHE -- no email address, mailing address or phone number.

As Kansas continues to battle a backlog of Medicaid applications, advocates for the elderly and disabled say a second, less visible barrier has developed: simply applying for Medicaid has become more difficult.

Paper applications can be hard to come by and inquiries to a call center can sometimes descend into lengthy holds. As the sign demonstrates, how to reach the right agency is not always clear.

"If you're a consumer and you're trying to navigate this -- if you're frail, if you've got a head injury, if you've got any cognitive challenges, if you have to physically maneuver around in a wheelchair or a walker -- how hard have we made this system for people at this point?" Mitzi McFatrich, director of Kansas Advocates for Better Care, said.

Kansas appears to be taking some steps to make the process more user-friendly, however. This past week, in response to questions for this story, the state announced it would make paper applications more readily available at DCF offices.

DCF also said it would update signage at its service centers to include phone numbers, a mailing address and website.

The state's ongoing troubles with processing Medicaid applications once they are made -- and the resulting backlog -- has caused angst and anger, and the state says it is making progress. Less explored, however, are the hoops someone in need of care must jump through just to get in line.

Interviews with advocates and others closely involved in helping individuals get onto the state's Medicaid program, known as KanCare, indicate no one event has made the process into the sometimes frustrating experience it is today. But they do suggest contributing factors at play: problems plaguing an electronic eligibility system and most recently the transfer of some administrative functions from DCF to KDHE.

Amid the continuing changes to KanCare, the number of people in the program has declined over the past year, according to the most recent data available. After increasing numbers of beneficiaries in the program's first two years, KanCare has lost thousands of participants during the last 12 months -- raising questions about whether some are unable to get the help they seek.

State to boost

paper applications

Joining KanCare begins with filling out an application, which can be completed online or on paper. Yet obtaining a paper copy has become more difficult, advocates say.

In January, KDHE assumed responsibilities for making financial eligibility determinations for elderly and disabled assistance that had been previously handled by DCF. Advocates indicate that as eligibility determinations moved away from DCF, the agency's consumer-friendliness declined.

Paper applications for Medicaid aren't often available in local DCF offices. Individuals are instead given instructions for requesting a paper copy by mail or contacting the KanCare call center.

McFatrich said she doesn't know where someone can get a print application anymore.

"You walk into a DCF office, you ask for a print copy. They don't have a print copy, they say they're not going to get a print copy, nor do they offer to print you a copy off of the internet even though they could do that because they don't really want print copies," McFatrich said.

While all aspects of society and government have for years been marching away from physical paper and toward electronic documents, this change poses acute challenges to populations served by KanCare -- the elderly, the poor and those with physical and mental disabilities.

Individuals may not have home access to the internet or be technologically savvy. In addition, the time needed to successfully fill out an application may exceed the time provided at public access computers, like those found in libraries.

"The people that we work with have a very low level of connectivity. A very low level. So people don't have computers, they don't have internet service, can't afford the cable or what have you," said Mike Oxford, director of the Topeka Independent Living Resource Center.

The apparent difficulty in obtaining paper applications comes as the state continues to roll out an electronic eligibility system known as KEES. Parts of the system have been brought online, but the project as a whole has been plagued by delays and problems.

Those problems contributed to the formation of a backlog in the processing of Medicaid applications. The state said this week it had reduced the backlog to about 5,500 at the end of April, down from about 18,000 in February.

Electronic issues have some who work with potential Medicaid recipients eyeing paper applications with greater interest. KDHE told lawmakers in April during a meeting of the KanCare Oversight Committee that the agency has paper applications.

Angela de Rocha, a spokeswoman for the Kansas Department of Aging and Disability Services, replied to questions sent to KDHE. She said paper applications can be obtained at Aging and Disability Resource Centers, local health departments, Indian health centers and DCF service centers.

The chairman of the KanCare Oversight Committee, Rep. Dan Hawkins, R-Wichita, said Thursday he hadn't heard of a lack of paper applications. Hawkins said he would look into the issue and said paper applications need to be available.

"That becomes a challenge and they have to have something to navigate that system. That will be something I will put on my agenda," Hawkins said.

DCF said in response to questions about the reported lack of paper applications that it would begin stocking them at its locations.

"Due to recent requests, DCF has agreed to be a source for medical applications for KDHE. Offices will be receiving a supply of applications," DCF spokeswoman Theresa Freed said.

In the meantime, Freed said individuals can request a paper application at 1-800-792-4884, or apply online at KDHE's KanCare application site. Individuals can continue to drop off completed paper Medicaid applications at DCF offices until Dec. 31, 2016.

As for the sign at the Topeka DCF office directing people to KDHE with no contact information, Freed said that DCF keeps KDHE business cards at its service centers with contact information for the medical programs that are distributed to applicants. The agency also has monitors in its service centers with messages about the transition of eligibility processing from DCF to KDHE and how people can apply for KanCare.

However, following inquiry by The Capital-Journal, Freed also said the agency would change its signs.

"We will update with contact information," Freed said. "We strive to be as helpful as possible, especially during times of transition."

On Thursday, Freed provided a copy of the updated sign and said it should start going up at DCF offices that afternoon. As of Saturday afternoon, the old sign remained in place at the entrance of the Topeka DCF office.

Call center

frustration

Wendy Coates, who acts as a guardian for a 60-year-old disabled man, said she once tried using the state's KanCare call center.

She eventually gave up.

"It's like calling Social Security. You're going to be on the phone for an hour, hour and a half. It's just very, very cumbersome," Coates said.

Coates is far from alone, and even the state has acknowledged long call hold times in the past. Since the beginning of the year, calls to a KanCare hotline have routed to a KDHE center housed at Forbes Center.

Known as the KanCare Clearing House, some calling in have faced holds in excess of an hour. Callers are supposed to be able to apply for KanCare, check on their application and report problems with the application process through the call center.

"The experience for consumers at the call-in center two months ago, maybe three months ago, was that you call and you're put on hold, anywhere from 30 minutes to an hour and a half," McFatrich said.

For individuals seeking to speak to a live person, the call center has taken on greater importance as in-person appointments for help are difficult to obtain. De Rocha said that when KDHE took over eligibility determinations, a decision was made to maintain a reduced presence in some areas of the state through 18 workers. Those workers are available by appointment. Thirteen of the positions are currently filled, de Rocha said.

"These workers' primary role is to process Home- and Community-Based Services applications and to engage HCBS community partners to ensure timely and accurate determinations for those populations," de Rocha said.

Additionally, she said the state has deployed 50 staffers from DCF to help process applications and renewals for the elderly and disabled population.

Meanwhile, KDHE has moved to cut down call waiting times. Aaron Dunkel, KDHE deputy secretary, said hold times have declined. Wait times for the call center at one point averaged about 40 minutes, he said this past week. The average wait time is now about 11 minutes, Dunkel said.

De Rocha said Friday the wait time stood at 14 minutes. Wait times had been reduced to 10 minutes, she said, but spiked over the past month.

Some question whether the declining average wait time actually represents the amount of time before a caller receives assistance. Advocates and lawmakers indicated they have heard of individuals having their calls answered relatively quickly, only to be placed on a second, lengthy hold before actually receiving help.

"I've heard a lot of that, and it's clear why," Sen. Laura Kelly, D-Topeka, said. "One, the system is totally dysfunctional and technologically dysfunctional. That KEES system just doesn't work. And then they've got staffing issues. They don't have the resources to handle the volume."

In one case, a caller's second hold time was four hours, said Sean Gatewood with the KanCare Advocates Network. He stressed he doesn't know if that is typical by any stretch.

"You get that initial pickup and then you're back on hold," Gatewood said.

De Rocha said the average wait time reflects the amount of time before a caller gets assistance, not just a first contact.

"Wait times are calculated on the basis of how long it takes to get a caller to the right place to receive assistance, not just the time to initially answer a call," de Rocha said.

Enrollment down

Changes over the past year to KanCare have sparked worries that individuals who need medical assistance will be shut out. Whatever the reason, data show that the number of people in the program has dropped.

According to figures taken from Kansas Medical Assistance Reports, the total number of KanCare beneficiaries has fallen from February 2015 to February 2016, the most recent month for which data was available.

The number of beneficiaries stood at 412,320 in February 2015. It remained relatively steady in March and April that year, peaking in April at 412,331.

Since then, however, it has been trending down, with some spikes interrupting the decline. The total number of beneficiaries stood at 402,932 in February 2016, up slightly from 400,081 in September, the lowest recorded figure during the past year.

"I think it's pretty clear those structural changes are leading to those people not being able to come into the system who clearly need it," Gatewood said.

De Rocha said a number of reasons could be at play. She ruled out financial eligibility factors such as income and asset limits, saying those hadn't changed.

"Some individuals have obtained their coverage through Obamacare, others entered the workforce and receive employer--provided insurance (the very low state unemployment rate indicates this may well be a factor)," de Rocha said in a statement.

The state's unemployment rate in April stood at 3.8 percent.

Oxford said the drop doesn't make sense to him.

"Kansas is one of the most rapidly aging states in the country," Oxford said. "With aging comes lower income, including poverty and health problems and disability."

Credit: Jonathan Shorman [email protected]