Politics & Government

Kansas to KanCare contractor: Your improvement plan isn’t good enough

Seniors struggle with KanCare Clearinghouse

Kansas made a number of changes since 2015 meant to make the Medicaid eligibility process more efficient. Advocates for the elderly say the state instead set up a maze that seniors are getting lost in.
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Kansas made a number of changes since 2015 meant to make the Medicaid eligibility process more efficient. Advocates for the elderly say the state instead set up a maze that seniors are getting lost in.

A Kansas Medicaid contractor facing allegations that it’s not living up to the terms of its $1 billion a year contract insists it’s doing better.

The state says the company still isn’t doing well enough.

Aetna holds a key contract in managing KanCare, the state’s privatized Medicaid program. The Kansas Department of Health and Environment raised a range of concerns with the company last month, including credentialing medical providers for billing and problems with claims.

Aetna responded with a corrective action plan and letter, dated Aug. 7, that KDHE released Tuesday. The company says it’s addressed several concerns and many others are “well on their way to being brought into compliance” under the contract.

But KDHE rejected Aetna’s plan.

“Upon review, KDHE does not feel that the plan submitted by Aetna adequately addresses the State’s concerns, nor does it present a clear path to compliance,” agency spokeswoman Ashley Jones-Wisner said in a statement.

KDHE has asked Aetna to submit a new corrective action plan and “plans to meet with Aetna leadership to negotiate a resolution that best serves KanCare members,” the statement says.

Aetna officials said they are “cooperatively working with providers and other stakeholders and taking accountability to continually improve our operations and resolve areas of concern,” echoing a previous statement.

“KDHE has issued a noncompliance letter related to those areas of concern,” the company said in a prepared statement. “We submitted a response with a remediation plan and we are currently working with the State to enhance the document and add a greater level of detail. Aetna Better Health of Kansas successfully facilitates our members care and health improvement on a daily basis, and is fully committed to a successful long-term partnership with KanCare stakeholders.”

Jones-Wisner did not release Aetna’s corrective action plan, saying it is not public since it’s not finalized.

In Kansas, Medicaid covers about 400,000 people total. Nearly all of them are children, the elderly and frail, disabled people and pregnant women.

Aetna is the newest KanCare contractor. But more than half a year after it began helping run the Medicaid system, issues with service are continuing.

A search of an online database of unresolved claims issues showed that Aetna had 28 systemic problems reported since January, compared to four for Sunflower State and one for United Healthcare – the other KanCare contractors.

The providers affected by the issues include hospitals, doctors, pharmacies and those who provide support services for people with disabilities.

Kansas City Star reporter Andy Marso contributed to this story

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