Kansas Nursing Homes Get Some Relief From Medicaid Processing Delays

Mar 25, 2016

Cindy Luxem, president and CEO of the Kansas Health Care Association, said the reprieve is good news for the non-profit nursing homes her organization represents.
Credit File photo / Heartland Health Monitor

Nursing home representatives breathed a sigh of relief Friday as the state announced a program to help them get Medicaid money for some residents whose applications are stuck in processing delays.

The delays — traced back to a computer system switch in July and administrative changes in January — have led to thousands in unpaid bills for facilities and prevented some frail Kansans from finding a nursing home bed.

The Kansas Department of Health and Environment and Kansas Department for Aging and Disability Services announced Friday that they will allow some facilities to petition for half-payments for some residents whose Medicaid applications or renewals are still processing.

Cindy Luxem, president and chief executive of the Kansas Health Care Association, said that was good news for the for-profit nursing homes her organization represents. She praised the state and the three insurance companies that administer Kansas Medicaid, or KanCare.

“We’re ecstatic that the state has come up with some kind of an idea,” Luxem said. “I know the insurance companies were part of this also, so we appreciate their collaboration to try and get some relief to these providers.”

Debra Zehr, president and chief executive of LeadingAge Kansas, which represents nonprofit nursing homes, was less effusive.

“It will help maybe a little bit if it comes off without a hitch, but it’s still not the full solution,” Zehr said.

The state’s plan allows facilities to apply for advance payments only for residents whose applications have been pending for 60 days or more.

Federal rules stipulate the state must respond to Medicaid applications within 45 days unless they require a disability determination. Officials with the Centers for Medicare and Medicaid started asking the state for biweekly updates on the backlog last month, when there were 18,000 applications pending and almost 8,000 that had been out for more than 45 days.

“The solution is to fix their systems so they can process all these applications within the 45 days that’s currently required,” Zehr said.

After facilities apply for advance payments for residents, the state’s plan is to “complete a high-level triage of the applicants to determine their probability of becoming eligible” and then offer the facility a payment based on 50 percent of the calculated monthly rate.

Facilities will have to repay the state if the applicants are later determined not to be eligible for Medicaid.

The state also plans to give priority to “smaller facilities versus large, corporate-owned facilities.”

Luxem said corporate-owned facilities “probably need help too” but her organization understood the philosophy behind that provision.

Zehr said more details were needed about what it meant.

“Some corporate systems have small facilities throughout the state,” Zehr said. “I think they still have more clarification and explanation to do. I hope they’ve got enough staff on board to process all this.”

Zehr and Luxem both said the announcement shows that the voices of nursing home administrators are being heard in Topeka, after their organizations spent months raising alarms about the Medicaid processing problems.

“We’ve obviously done a lot of advocacy work on this,” Zehr said. “They’re listening. It’s frustrating that the solutions are so slow.”

Andy Marso is a reporter for KHI News Service in Topeka, a partner in the Heartland Health Monitor team. You can reach him on Twitter @andymarso