Pressure mounts: 12,000 caught in a backlog

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October 18, 2009

Anonymous The Joplin Globe Sun Oct 18, 2009, 11:35 PM CDT

By Andra Bryan Stefanoni

news@joplinglobe.com

PITTSBURG, Kan. — When Candice Sinclair was nearing the end of her pregnancy, she applied for Medicaid to cover her expenses and those of her soon-to-be-born son, Jake.

That was in June. Their applications still haven’t been processed, meaning Sinclair is left without means to pay an estimated $5,000 hospital bill, and for Jake’s first year of immunizations and checkups.

“It’s frustrating,” Sinclair said. “It makes me mad. We’ve been waiting four months, almost five.”

She began a new job last week, but she won’t be eligible for health insurance until January. The baby’s father, meanwhile, is self-employed and does not have insurance.

Sinclair’s application is one of 12,000 caught in a backlog by the contractor that processes applications under the direction of the Kansas Health Policy Authority. Applications are supposed to be processed in two to three weeks — six weeks at the maximum.

Peter Hancock, public information officer with the authority, said the agency saw the backlog coming almost a year ago, and as a result it “rang the alarm bell.” The agency requested $1.5 million from the Kansas Legislature to fund the staff needed to speed up the work. The governor called for an allocation of $500,000, but the Legislature didn’t fund it — something not unexpected, Hancock said, in light of shortfalls in state revenue and many other agencies also requesting money.

“In social services, this is the constant paradox: When there’s the greatest need, you have the least amount of resources to pay for it,” Hancock said. “The revenue flowing in is plummeting as more and more people are needful.”

The problem in Kansas lies in two main issues, as Hancock sees it: rising unemployment and outdated technology.

Unemployment

The Kansas unemployment rate has continued to rise all year, especially in Southeast Kansas, where several large companies closed or laid off workers late last year. The closing of the Superior Industries plant, Pittsburg’s largest private employer, put more than 600 people out of work.

“It is directly tied, we believe, to the economic downturn and rising unemployment rate in Kansas,” Hancock said. “There also are a number of people who may still be working, but either their employer isn’t offering health insurance anymore or isn’t paying the premiums.”

According to the Kansas Health Institute, 40.9 percent of adult Kansans without health insurance worked full time, year-round, in 2007-08.

As of September, Medicaid covered 265,787 Kansans, with an additional 38,683 children up to age 19 covered by the State Children’s Health Insurance Program, or SCHIP. That equates to roughly 10 percent of the state population.

Four of the six counties with the highest rates of people on Medicaid or the SCHIP programs are in Southeast Kansas, following Wyandotte County, which is in first place with 27.82 percent of its population in those programs.

Cherokee County is second, with 27.28 percent; Labette County is third at 25.28 percent; and Bourbon County is fourth at 24.83 percent. Crawford County is sixth, with 24.27 percent not covered, which equates to one of every four people.

“We saw this coming,” Hancock said. “We’re not surprised. We’re disappointed, obviously, that there are so many people uninsured and it’s taking so long.”

Technology

Also contributing to the backlog is what Hancock called a “very antiquated, old, inefficient eligibility system.”

“The technology used to process and certify eligibility and get people enrolled dates back to the mid-1980s. It predates Windows,” he said.

The result, he said, is a “a very labor-intensive process” of handling the applications.

“We sent two different letters to all 165 legislators, both by e-mail to work and home, and a snail mail to their home, alerting them of this back in late April and early May,” Hancock said.

There is some help coming. In September, Kansas received a $40.3 million grant from the federal Health Resources and Services Administration, to be spread out over five years, to spend on modernizing the enrollment system. It ultimately will allow the Kansas Health Policy Authority to offer online applications, but getting to that point will take some time.

“We also have identified some savings in other parts of our budget, and we’ve shifted that money over to pay more overtime at the clearinghouse to try and work through the stack of applications over there,” Hancock said. “And as a result, that has helped the backlog go down significantly.”

Health center

While they waited, Sinclair and her young son turned to the Community Health Center of Southeast Kansas, 3011 N. Michigan St., Pittsburg. The “safety net” clinic, which opened in 2007, offers physical, mental and dental health in addition to a pharmacy. The center has 17,000 patients.

The center receives federal grant dollars for the uninsured. Up until a few months ago, that helped it stay afloat.

But Krista Postai, director, said that in the past six months, the center went from breaking even to losing $10,000 a month.

“We’ve weathered economic setbacks before, but this one seems to be devastating,” she said.

The center is seeing 20 new patients per day, and few have coverage.

“We used to see 35 percent who were self-pay, and within six months that has shifted to 50 percent,” Postai said. “There was a family that last year was making $80,000. This year, they’re making nothing, because both were laid off. They wake up a year later and have no health insurance, no income. How do you deal with that?

“We’re seeing one in three children uninsured now, and it used to be one in five. Part of that is a definite slowdown in the processing of Medicaid and SCHIP. It’s taking as long as three to four months for our patients to see their applications processed or renewed.”

That worries Postai for many reasons. Beyond keeping the health center open, she’s concerned that the uninsured are waiting too long to bring in children who are sick, so their illnesses get worse.

She’s also concerned about what happens to high-risk children who must be referred to specialists who don’t accept uninsured patients.

And, she worries about what will happen when the eligibility requirements for SCHIP ease up in January. Hancock estimated that would mean an additional 4,000 children could apply in 2010 and as many as 10,000 by 2015.

“I thought that the problem could go from bad to worse simply because we will have lots more kids in the system Jan. 1,” Postai said. “A lot of advocacy groups are really pushing people to sign up, so there will be an influx of applications based on those efforts.”

For Sinclair, the frustration and costs continue to climb.

“We still don’t know what’s going to happen,” she said. “We just had to send in another application. We’ve done everything they’ve asked, and we still don’t have it.”

State program

SCHIP, the State Children’s Health Insurance Program, is an additional insurance program for Kansas children 18 and under in families that make too much money to qualify for Medicaid, but either cannot afford or don’t have access to private insurance.