Legislative auditors can’t confirm Medicaid backlog numbers

By Andy Marso, September 21, 2016

Legislative auditors said Wednesday they can’t confirm that the Medicaid application backlog numbers state officials have reported are correct.

Applications have been backlogged for about a year following the rocky rollout of a new computer system, an administrative decision that funneled all applications through a single state agency and a larger-than-expected influx of applications during the Affordable Care Act open enrollment period.

The auditors said the Kansas Department of Health and Environment gets the backlog number from Accenture, the contractor that built the new software platform known as the Kansas Eligibility Enforcement System, or KEES.

Accenture pulls the number by querying the KEES database. Auditors said they watched one query, but without having access to the underlying data they could not determine the accuracy of the state’s numbers.

“Although the query appears to be written by knowledgeable staff with considerable programming expertise, its complexity results in a greater chance of error,” the auditors wrote in their report. “In this report we will use the numbers generated by the programming language, but the reader should be aware that the actual number of backlogged applications may be higher or lower to an unknown extent.”

Head auditor Scott Frank told members of the Legislative Post Audit Committee that KDHE gave all access requested. Auditors did not request access to the underlying data because combing through it would have been time-consuming, and they wanted to ensure they could give legislators at least a preliminary look at the causes of the backlog before the next session.

Frank said if the committee decided to request a more thorough vetting of the backlog, his team would seek access to the raw data.

The auditor who presented the report, Brad Hoff, said that although the state’s backlog numbers could not be independently confirmed, the auditors believe they’re “not grossly inaccurate.”

Earlier estimates were low

Medicaid is funded by federal and state dollars, and federal rules dictate that applications are processed within 45 days unless they require a federal disability designation, in which case they are to be processed within 90 days.

Federal officials began monitoring the Kansas backlog in February, requesting twice-monthly status updates.

KDHE Secretary Susan Mosier notified federal officials in June that those reports had been underestimating the application backlog and the actual number was about four times higher.

She placed responsibility for the error on Accenture. After the reports were corrected, the number of applications waiting 45 days or more topped out near 14,000 in June.

KDHE took a number of steps to reduce the backlog, including adding personnel to Maximus, the contractor that staffs the facility where most applications are processed.

They also borrowed 50 workers from the Kansas Department for Children and Families, which had been responsible for long-term care Medicaid applications until Gov. Sam Brownback transferred those responsibilities to KDHE with an executive order that went into effect Jan. 1.

Aaron Dunkel, KDHE deputy secretary, said Accenture also has made a number of improvements to KEES so it is easier to use.

Dunkel said the number of backlogged applications as of Sept. 2 was 3,385, including 1,740 that can’t be processed without a disability designation.

“We continue to see good progress,” he said.

The agency plans to have the backlog down to its historic average in the low hundreds before the next ACA open enrollment period opens in November, Dunkel said.

Sen. Julia Lynn, a Republican from Olathe, said she was pleased with the progress.

“That’s a dramatic drop in just a short amount of time, so I see that as a positive,” Lynn said.

Consequences linger  

The extra staffing has cost KDHE about $2.3 million, according to the audit. Dunkel said that would be reflected in the agency’s next budget request. But Shawn Sullivan, the state’s budget director, has estimated that the state saved about $10 million due to lagging Medicaid enrollment following the KEES switch.

About 35,000 annual renewals are pending for Kansans already on Medicaid.

As the backlog grew, KDHE officials set aside annual the renewals to focus resources on new applications, while promising that Kansans awaiting renewals would not be dropped from the Medicaid rolls.

KDHE officials told the auditors that historically no more than 5 percent of renewals have been denied and therefore agency leaders “are not concerned that a significant number of individuals who currently receive services are no longer eligible.”

But Rep. Virgil Peck, a Republican from Tyro, said 5 percent of the 35,000 would be about 1,700 and asked if there would be any efforts to “recapture those benefits.”

Nursing homes also have reported long-term damage to their finances and their relationships with vendors as they care for residents who wait months for Medicaid coverage. 

Dunkel said the agency had improved its process of working with the facilities to get the long-term care applications done so they can be reimbursed.

The nonprofit KHI News Service is an editorially independent initiative of the Kansas Health Institute and a partner in the Heartland Health Monitor reporting collaboration. All stories and photos may be republished at no cost with proper attribution and a link back to KHI.org when a story is reposted online.

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