Democratic lawmakers grilled the acting secretary of health and environment Tuesday over what they called bureaucratic hurdles for people trying to receive Medicaid services in Kansas.
Rep. Jim Ward, D-Wichita, pressed Susan Mosier, who took over as the Kansas Department of Health and Environment’s interim secretary earlier this month, about why Kansans must fill out separate applications for Temporary Assistance for Needy Families, also called welfare, and Medicaid. The programs had a joint application in the past.
“Who made the decision to disconnect the application process?” Ward asked at a meeting of the KanCare oversight committee. “We used to have presumptive eligibility for Medicaid (for TANF recipients) … so that would seem to be counterintuitive that we disconnected the two, which would make it harder to apply for Medicaid.
“No one’s articulated a reason why I would need different information to apply for food than I would for health care,” Ward added later.
The Kansas Department of Health and Environment oversees Medicaid, while the Department of Children and Families oversees the temporary assistance program.
The programs – both meant to help the poor – began requiring separate applications in November 2011, a change the DCF says was prompted by federal policies.
During the meeting, Mosier told Ward the decision to have separate applications had been made by a previous administration and had been in place for a decade. DCF documents say the change was enacted in 2011, during Gov. Sam Brownback’s first year as governor but before the state privatized Medicaid under the KanCare umbrella.
Ward said he was frustrated that Mosier, who previously was the state’s Medicaid director, would be uninformed on the matter.
Asked why Mosier had been misinformed, Sara Belfry, a spokeswoman for the Department of Health and Environment, said the policy change had been made by the DCF. She deferred comment to that agency.
Theresa Freed, spokeswoman for the DCF, said changes to the temporary assistance program at the federal level caused the agency to make the policy change in 2011.
“Before 2011, the eligibility for cash assistance and caretaker medical were very similar, so the information needed to determine eligibility was easily recorded on a single application,” Freed said in an e-mail. She said the changes to eligibility mean that a person “can qualify for one program and not the other.”
Kansas Action for Children, a group that advocates for needy children, noted in its testimony to the committee that the number of children between the ages of 1 and 5 enrolled in Medicaid has decreased by more than 3,000 since 2012, saying that it “appears that the administrative policy changes to the TANF program may be negatively affecting Medicaid enrollment.”
‘Set of services’
Sen. Laura Kelly, D-Topeka, questioned Mosier about another bureaucratic matter. People with intellectual and developmental disabilities are automatically enrolled in “health homes” as part of the KanCare system unless they opt out. In some cases, that means people are being switched from their current case managers.
Belfry said the health homes are “not a physical structure” but are a “set of services that is provided to someone with a serious mental illness or a chronic condition that supplements their current Medicaid benefits and tries to wrap around services more completely.”
She said people who were eligible for health homes were notified that they were being enrolled, and they had the opportunity to opt out at any time. She said those already enrolled in a health home who decided they did not want the services could opt out.
Kelly and Ward said that approach created confusion, because some of the individuals have guardians who were not informed.
Marilyn Kubler, a Johnson County resident whose adult daughter has disabilities and receives Medicaid services, expressed frustration in testimony submitted to the committee.
“Letters were sent to individuals who cannot read or write or use the telephone and were told, in the letter to let the state know if they didn’t want to be included. Some individuals did not even get a letter and yet were ‘opted in,’ ” Kubler wrote. “We have raised the question why these letters were not sent to the guardians as well as the individuals. It seems not only unethical but illegal to put someone in a program they don’t understand without consultation with their guardian.”
Ward said that transitioning to health homes had disrupted services for some people who were previously working with a targeted case manager. He said there had been a failure to coordinate the transition in some cases.
“It would appear from the outside looking in you make barriers to make people fall through the cracks,” he said to Mosier.
Mosier said she could understand why that perception would exist but added “the goal is to create better integration and coordination and care for individuals.”
“We surround them with a team of care providers who can meet all their health needs – their behavioral health needs, their physical health needs, their long-term services and supports,” Mosier said.
Rep. Dave Crum, R-Augusta, the oversight committee’s outgoing chairman who will not return to the Legislature in January, said the state was allowing beneficiaries to keep their targeted case managers but that in some cases, that required opting out of the health homes.
“I don’t argue with the fact that people probably had a lot of confusion with getting set up in the health homes,” Crum said. “But the reason for it is we’re trying to do the best thing for the client.”