Who is eligible
Children up to age 1 with family income up to 166% of FPL. Children ages 1-5 with family income up to 149% of FPL. Children ages 6-18 with family income up to 133% of FPL; children with family income up to 242% of FPL are eligible for CHIP. See the eligibility guidelines for those who are elderly or disabled.
- healthinsurance.org contributor
- September 28, 2016
In September 2016, Sandy Praeger, a Republican and former Kansas Insurance Commissioner, called on Governor Brownback and Kansas lawmakers to expand Medicaid, saying that there’s “no logical explanation” for the state’s continued rejection of federal funding for Medicaid expansion, and noting that the decision has been based on politics rather than cost analysis.
And the state’s primary election in August 2016 resulted in several moderate Republicans getting onto the ballot for November, energizing Medicaid expansion advocates. Supporters are now more confident than ever that they can get a bill passed in 2017 to expand coverage, particularly given that several of the primary winners had been outspoken about their support for Medicaid expansion.
Medicaid programs and eligibility vary widely across the country. The federal government sets minimum eligibility levels for specific populations, but states can choose to set their eligibility levels higher than the federal minimums. All states are required to provide Medicaid to certain populations — like low-income children — to qualify for federal Medicaid funding. States that opt to cover additional populations are eligible for additional funding.
Unfortunately for low-income individuals in Kansas, the existing Medicaid program — which is called KanCare — is quite limited.
Kansas is one of 19 states that has not yet accepted federal funding to expand Medicaid to adults with income up to 138 percent of the federal poverty level. As a result, childless adults are not eligible for coverage regardless of how low their income is, and parents with dependent children can only qualify if they live in extreme poverty.
KanCare eligibility guidelines
Individuals who meet the following income limits qualify for Medicaid in Kansas:
- Children up to age 1 are covered with family income up to 166 percent of the federal poverty level (FPL)
- Children ages 1 to 5 are covered with family income up to 149 percent of FPL
- Children ages 6 to 18 are covered with family income up to 133 percent of FPL
- Parents with dependent children are eligible with household income up to 33 percent of FPL. For a family of four, that’s about $8,000/year in 2015.
- Children with family income too high to qualify for Medicaid are eligible for the Children’s Health Insurance Program (CHIP); the income limit is 242 percent of FPL
- Individuals who are elderly or disabled may also qualify for KanCare; see the eligibility guidelines
As of August 2014, enrollment in Kansas Medicaid/CHIP was 400,994. By July 2016, it had increased to 422,549, which is a 12 percent increase since 2013.
From 2013 through at least 2015, Medicaid enrollment in Kansas among children age 1 to 5 had been declining, although state Medicaid officials haven’t pinpointed a specific reason and note that some of the children may be covered under CHIP instead (CHIP enrollment has grown slightly since 2013).
Kansas Action for Children, a state advocacy group, believes that the decline in Medicaid enrollment among young children is correlated with the fact that Kansas decoupled applications for Medicaid and TANF a few years ago. The plan was for the new Kansas Eligibility Enforcement System (KEES) to begin coordinating enrollment in various public programs in 2013, but it’s been delayed repeatedly and the system was not yet fully operational as of fall 2015.
How to enroll in KanCare
Kansas Medicaid has been experiencing an enrollment backlog since late 2015, due to a combination of a new computer system, all enrollments going through a single state agency, and an influx of new enrollees during the ACA’s enrollment period (Medicaid enrollment is year-round, but tends to peak during the individual market’s open enrollment period due to outreach and advertising; despite the fact that Kansas hasn’t expanded Medicaid, the “woodworker” effect means that people who were already eligible have been enrolling in larger numbers since 2014.
The state is working to get the backlog down to its historical levels before the 2017 individual market open enrollment period begins in November 2016.
For children and families:
- Apply online (or through Healthcare.gov).
- Complete an application. English and Spanish versions are available, or call 1-800-792-4884 to have an application mailed to you.
- You may return the application by fax: 1-800-498-1255.
- You may also submit the application in person or by mail. Use the office locator tool to find the address or phone number for a nearby Department for Children and Families (DCF) office.
- If you need help with the application process, contact DCF toll free at 1-888-369-4777.
For elderly or disabled individuals:
- Apply online.
- Complete an application. English and Spanish versions are available, or call 1-888-369-4777 to have an application mailed to you.
- Return the application by fax: 785-296-4813.
- Alternately, you may submit your completed the application in person or by mail. Use the office locator tool to find the address or phone number for a nearby Department for Children and Families (DCF) office.
- If you need help with the application process, contact DCF toll free at 1-888-369-4777.
Advocates continue to push for expansion
Although the uninsured rate in Kansas is at an all-time low of 10.5 percent, advocates note that there are 50,000 uninsured Kansas residents who would be eligible for Medicaid if the state were to expand coverage.
Kansas decided against expanding its Medicaid program despite a December 2013 poll that found 72 percent of registered Kansans voters favored expansion. The Kaiser Family Foundation estimates that 49,000 Kansans are in the coverage gap, given the state’s rejection of Medicaid expansion. Individuals in the coverage gap earn too much to qualify for Medicaid, but not enough to qualify for premium tax credits that would help them purchase private health insurance through the marketplace.
Many Kansas lawmakers and Governor Sam Brownback have continued to reject Medicaid expansion, but it will likely be an issue once again during the 2017 legislative session.
In October 2015, Mercy Hospital in Independence, Kansas announced that it would close, becoming the first Kansas hospital to shut down in nine years. The hospital’s closure has been linked to the state’s rejection of Medicaid expansion. In states that don’t expand Medicaid, the uninsured rate remains higher and hospitals continue to struggle with higher levels of uncompensated (charity) care – particularly since federal funds to offset uncompensated care costs are being phased out now that states have the option to expand Medicaid.
Mercy Hospital’s announcement triggered renewed calls for Medicaid expansion in Kansas, but Governor Brownback’s administration has thus far remained steadfast in their refusal to expand Medicaid to all adults with household income up to 133 percent of the poverty level. In response to editorials calling for Medicaid expansion in the state, an email from Brownback’s deputy communications director Melika Willoughby described Medicaid expansion as “morally reprehensible” and an “Obamacare ruse [that] funnels money to big city hospitals.” The email also said that Medicaid expansion would create a new entitlement “for able-bodied adults without dependents, prioritizing those who choose not to work before intellectually, developmentally, and physically disabled, the frail and elderly, and those struggling with mental health issues.” [This is disingenuous though, as 60 percent of adults in the coverage gap are in an employed household; the problem is that their jobs are low-paying and don’t provide health insurance.]
A Medicaid expansion bill, HB 2319, was introduced in the 2015 session and got a hearing before the House Health and Human Services Committee. The acting secretary for the Kansas Department of Health and Environment testified that expansion would cost the state $2.4 billion between 2016 and 2025, and the committee didn’t act on the bill.
The federal government will always pay at least 90 percent of the cost of Medicaid expansion, but states will be responsible for ten percent of the cost by 2020. However, Kansas hospitals are projected to lose $2.6 billion between 2013 and 2022 if the state continues to reject Medicaid expansion. And the state is missing out on $5.3 billion in federal funding over that same time period by not expanding Medicaid. And a new Kaiser Family Foundation study found that states that have rejected Medicaid expansion actually saw their share of Medicaid spending increase twice as much in fiscal year 2015 as state Medicaid spending in states that have expanded coverage.
Brownback’s position remained unchanged heading into 2016; he maintains that the state cannot afford to expand Medicaid, and that he would only consider expansion if it were budget neutral. Brownback has said that the state should not move forward with expansion of Medicaid while they have currently-eligible residents who are on waiting lists for Medicaid services (part of that problem can be attributed to issues with KanCare, discussed below).
The Alliance for a Healthy Kansas has renewed their call for Medicaid expansion in 2016, and launched a state-wide campaign to educate voters about the lawmakers who will be on the ballot in November, and how voters can influence the state’s course on Medicaid expansion. The advocacy organization was elated with the results of the 2016 primary in August, and feel confident that Medicaid expansion might become a reality in Kansas during the 2017 legislative session.
Controversy around KanCare
In 2010, Kansas began researching options to reform its Medicaid program to improve health outcomes and control costs. In November 2011, the Brownback administration announced its plans to move all Medicaid beneficiaries, including fragile populations like disabled individuals and nursing home residents, into managed care programs. The reformed program was given the name KanCare.
In September 2014, Democrats on the KanCare Oversight Committee requested an investigation of the contracting process with the three managed care companies that participate in KanCare. Those requesting the investigation cited reports that the FBI interviewed numerous people involved in the contracting process. In October 2015, Amerigroup, one of KanCare’s three managed care organizations, hosted a fund raiser for Republican members of the Senate Health and Welfare Committee, which oversees KanCare’s performance. The fund raising continues a trend of financial contributions to lawmakers from the private companies that contract with KanCare, and calls into question lawmakers’ willingness to provide meaningful oversight for KanCare’s performance.
Another area of concern was raised by a study conducted by the University of Kansas. Researchers found that nearly half of disabled individuals interviewed had problems accessing services through KanCare.
Finally, a former employee of one of the managed care companies that participates in KanCare has filed a lawsuit alleging fraud. Jacqueline Leary filed suit against Sunflower State Health Plan, and its parent company, Centene. Leary alleges she was wrongfully terminated after reporting potential fraud with her former employer’s network contracting practices for KanCare business.