TOPEKA — Dozens of primarily elderly or disabled Kansans lost their Medicaid coverage because of errors made by Aetna. Staff at the state health department discovered the problem, restored their insurance and stopped further cancellations.
Months later, state workers are still double-checking the work of Aetna Better Health — one of the three companies that helps run the state’s privatized Medicaid system — while Aetna puts together a permanent fix.
It’s one of the “top issues” on a list of problems that Aetna must correct to comply with its state contract, officials at the Kansas Department of Health and Environment said in an email.
Aetna didn’t grant an interview, but provided a brief statement, saying it remains “dedicated to serving KanCare members” and is collaborating with the health agency “to address all issues related to beneficiary eligibility.”
Kansas warned Aetna in July that it risked losing its state contract after months of complaints from health care providers that were struggling to collect timely payments and hitting other walls with Aetna. Aetna apologized, replaced its top leadership for the Kansas Medicaid program and promised better performance.
Aetna insures about 100,000 people under the state’s KanCare Medicaid program. And state officials said they meet with the company weekly to gauge progress.
The 42 people who got letters dropping them from Medicaid did so because Aetna handled some claims incorrectly, the state said. That prevented patients from hitting deductible-like spending targets that certain beneficiaries have to reach within six-month windows to keep coverage.
The health department said it found out about the problem in July and reinstated insurance, preventing coverage gaps for patients and delays in payment for doctors and other health care providers.
“They did not need to reapply,” agency officials wrote in an email. “Everything was done internally.”
In recent years, the KanCare application process — itself partly privatized — came with its own headaches for patients and providers alike, including monthslong waits.
In its statement, Aetna said it is “working collaboratively with the state to address all issues related to beneficiary eligibility.” That includes auditing claims to check its work.
“We are also regularly communicating with both beneficiaries and health care providers to minimize any potential disruption as we address these issues,” it said.
Celia Llopis-Jepsen reports on consumer health and education for the Kansas News Service. You can follow her on Twitter @Celia_LJ or email her at firstname.lastname@example.org. The Kansas News Service is a collaboration of KCUR, Kansas Public Radio, KMUW and High Plains Public Radio focused on the health and well-being of Kansans, their communities and civic life. For more Kansas News Service stories, visit ksnewsservice.org.