By Heather Braum, Kansas Action for Children

Kansas released the second set of data for how the year-long KanCare unwinding process is going, with data available through June 30, 2023, and has now broken out the data into age ranges and by county for those who had not returned a renewal form in April or May.

Since our last analysis of unwinding data, there have been only small increases in processed renewals, while there is a large increase in the number of letters sent out to KanCare members. One thing remains constant: Kansas kids remain at a significantly higher risk of losing their KanCare coverage during this process, even if they remain eligible for coverage.

Data breakdown, reported as of June 30, 2023, since the start of the unwinding process:

• 275,647 individuals sent a KanCare renewal letter
• 29,012 individuals renewed (including 18,492 in “family medical”)
• 7,432 individuals (including 6,339 in “family medical”) determined ineligible and their KanCare coverage was discontinued
• 45,837 individuals (including 40,005 in “family medical”) had KanCare coverage discontinued for procedural reasons but can re-enroll within the 90-day window review period
  • 62.3 percent of those in the 90-day window are children

What the Data Means and Lingering Questions

Thankfully, the state has now released data broken out by age range and county location for those who had not yet turned in a renewal form in April and May. This breakdown starts to give us a picture of how the unwinding is going for children, and the statistics aren’t good news: 62.3 percent of those in the 90-day window who have yet to return a renewal form are children.  

Particularly, more than two-thirds of those in the 90-day window are children in the counties of Chautauqua, Clark, Decatur, Finney, Ford, Grant, Gray, Greeley, Hamilton, Rawlins, Seward, Stanton, Stevens, Thomas, and Wyandotte.

These numbers sadly confirm our deep concern that Kansas children are at high risk of losing their coverage even if they remain eligible for KanCare.  

Between the first and second June data releases, there have been only small changes in the categories, other than a large increase in the number of renewal letters sent out. More than 275,000 renewal notices have been mailed out, yet only about 10 percent of those have been renewed (29,012 out of 275,647), and a little more than 3 percent have been determined to be ineligible after a review (7,432 out of 275,647). Pending reviews (those who have sent back a renewal form but haven’t been processed yet) so far haven’t been publicly reported by Kansas, even though the state is submitting this required data point to the Center for Medicare and Medicaid Services (CMS) through a monthly report.

Also, there appears to only have been a minuscule increase between those in the procedural disenrollment category (90-day window) between the two data releases (now at 45,837, up from 45,820). The Sunflower State Journal recently reported that these small changes are due to the state pausing disenrollments in May and June because of concerns about postal delays and other challenges.

There are month-to-month improvements in the call center numbers, indicating that the center is responding to customer service demands. Time matters for many KanCare members, as sitting on a phone indefinitely may mean running out of minutes on a cell phone plan or abandoning a call because a breaktime ends at work. We continue to watch this data closely, especially in light of the troublesome history with previous call center vendors.

How does Kansas compare to other states? Check out the KFF unwinding tracker and the Georgetown Center for Children and Families tracker for comparisons as more states continue to publicly release or update their unwinding data.

Missing Data

The state has now broken out the data for the 90-day window group by age and county. This a great start; however, it would be even more helpful to see this breakdown for all the different categories, including for renewals and disenrollments.

When looking at other states’ unwinding data, Kansas continues to be missing several key data points, many of which were submitted in a mandatory report to the federal government but were not posted publicly to the state’s unwinding website. These include:

• The number of pending reviews, or information that was turned in but hasn’t been reviewed yet. This could tell us if the state and the contracted call center fall behind on review processes, indicating if more staff should be hired or processes should be further streamlined.
• The percentage of reviews happening through automatic processes (ex parte reviews) or pre-populated forms. This could eliminate some of the red tape and administrative burdens that families face.

While not required to be reported to CMS, it would also be helpful to know more details of the reasons for why enrollees fall into the 90-day window. This would help advocates understand the different reasons for procedural disenrollments and direct targeted outreach, shift messaging, or change state policies.

We hope to see more data broken down further to know how the unwinding process is really impacting Kansas kids.

Opportunities for Removing Administrative Barriers

Back in June, the federal HHS Secretary sent a letter to all governors urging states to take full advantage of all flexibilities available for the unwinding process to greatly reduce the number of those losing coverage due to procedural issues and administrative barriers. CMS has a tracker identifying which states have been approved for the available flexibilities. Kansas is already taking advantage of at least four of the available flexibilities and is in the process of pursuing more.

Also, Kansas currently sends out renewal notices 30 days before they are due. Yet, other states are allowing for a longer response time. While there is a 90-day window for eligible families to still submit the necessary documents to reinstate KanCare, kids might not have the health coverage they need when they need it. If they are disenrolled, it will cost the state additional money to re-enroll these eligible kids.

We recognize that the state continues to work with CMS to identify additional flexibilities and policy clarifications, removing barriers families may face in the renewal process.

Continued Outreach Needed – Especially in Schools

With the first two data releases, it is obvious more KanCare members must be reached. Research has shown many Medicaid and CHIP beneficiaries are unaware of the renewal processes ahead. We call on all Kansans — including community, education, religious, and health organizations; businesses; public officials; and the media — to continue ongoing outreach to KanCare members across the state to spread the word about the ongoing renewal process so eligible Kansans — especially children — keep their coverage.

With back-to-school events in the next month, CMS has created a toolkit targeted at parents. Cover Kansas is also willing to provide materials or staff a table at events.

The state has provided Kansas-specific toolkits on their website (English; Spanish; other resources) for messaging options; additional messaging tools are available through CMS. Join the Kansas Medicaid Renewal Helper network to participate in monthly calls and receive important updates.

Review this national call to action to discover specific steps for enrollees to take. In general, KanCare enrollees must:

• Keep their contact information updated with the state.
• Watch their mail for renewal mailings from the state.
• Return signed forms as soon as possible (even if only partially completed).
• Watch for and quickly respond to follow-up communications.

Even if parents/caretakers are no longer eligible for KanCare, their children may remain eligible due to higher income limits, so parents must send back the renewal form.

What’s Next?

We’re encouraged to see the state begin to disaggregate some of the data so we and other advocates can analyze how kids are faring during this complicated renewal period. Including a breakout by age and county for those in the 90-day window is a helpful step, and seeing that a large majority of those are children only reiterates the need for continued outreach to Kansas families.

In the next data release anticipated in early August, we hope to see progress on the number of processed applications so eligible KanCare members can maintain the coverage they rely on to access needed and timely medical services.

[Heather Braum is the Health Policy Advisor at Kansas Action for Children.]