Seniors struggle with KanCare Clearinghouse
Kansas’s newest KanCare insurance company, Aetna, has experienced a range of problems — from missed payments to incomplete information.
Tuesday, its leader sought to make amends.
“I want to apologize for not living up to the expectations that I’ve had for our plan,” Randy Hyun, CEO of Aetna Medicaid, told lawmakers. “We preach operational excellence and we certainly have not demonstrated that to you.”
During frank testimony before a KanCare oversight committee, Aetna officials said the company was taking steps to quickly improve its performance. If Aetna continues to fail, it’s at risk of losing its KanCare contract, worth roughly $1 billion a year in state and federal funds.
Hyun has removed the management team that oversaw the KanCare contract. He said the leadership team is where “the accountability and the focus starts.” He expressed confidence the company now has the right leaders in place.
Aetna experts from across the country are also converging on Kansas to help sort through problems, Hyun added.
“Clearly, the feedback we’ve received and some of the issues that have been brought to our attention and some of the issues we’ve seen internally have been extremely disappointing,” Hyun said.
The promises of action came after health care providers vented frustrations Monday with the company and its performance in helping operate KanCare, which provides health coverage to some 400,000 low-income and disabled Kansans.
Jenna Krehbiel, who operates Cornerstone Clinic, a small outpatient mental health clinic in Salina, said payments stopped July 1. But several phone calls to Aetna didn’t produce a solution, she said.
Kehbiel said serving Medicaid patients is “near impossible” when one-third of their payments have stopped.
“Collectively, we request Aetna be reprimanded for their incompetence and request immediate payment for services rendered,” Krehbiel told lawmakers.
Todd Willert, CEO of Community HealthCare System, based in the northeast Kansas town of Onaga, said even simple tasks appeared to be out of reach for Aetna, creating confusion among patients. Aetna has wrongly requested refunds from providers and also made wrong payments to nursing homes operated by CHCS.
CHCS’s experience with Aetna has been “poor from the start,” Willert said, adding that he had no confidence in the company’s ability to resolve the problems.
Cindy Luxem, president and CEO of the Kansas Health Care Association, said the problems surrounding Aetna hearkened back to the launch of KanCare in 2013, when start-up issues created financial problems for health providers, which depend on on-time payments.
“Because of Aetna, are we reaching that point again?” Luxem said.
The Kansas Department of Health and Environment told Aetna in July that it was in jeopardy of losing its KanCare contract because of performance problems. In response, Aetna provided a corrective action plan, but state officials rejected it as insufficient.
Aetna and KDHE are working on a new plan now.
Aetna’s troubles mark a low for the company’s operations in Kansas. A little more than a year ago, it edged out Amerigroup for a coveted spot running KanCare. But Amerigroup fought the change, and a lawsuit over the decision remained unresolved until October, leaving Aetna less time to prepare.
Aetna has a long history serving Medicare patients in Kansas, but is new to Medicaid in the state. It offers Medicaid plans in more than a dozen other states, including California, Michigan and New York.
“This isn’t their first rodeo in states that do managed care for Medicaid. So I don’t understand what their problems are,” Rep. Brenda Landwehr, R-Wichita, said.
Adam Proffit, the Kansas Medicaid director, told lawmakers the state would prefer Aetna come into compliance so it can stay as a KanCare contractor rather than having to terminate the agreement. If Aetna doesn’t improve, 100,000 Kansans will eventually have to switch insurance plans, he said.
Proffit said Kansas doesn’t have an exact timeline for Aetna’s improvement, but indicated immediate action is expected.
“We will not let this drag on for years,” Proffit said. “We expect a quick turnaround.”