Representative Jim Ward

TOPEKA — Six months ago, Community Health Center of Southeast Kansas was just about breaking even.

Now, it’s losing $10,000 a month.

“Very simply, it used to be that one out of every five children we’d see was uninsured, now it’s one out of every three,” said Krista Postai, executive director of the Pittsburg safety net clinic.

“When 48 percent of your patients are children, that kind of increase is going to have major financial impact,” she said. “We can’t weather this storm much longer.”

Postai said applications and renewals that once took two to three weeks to process are now taking two, three, sometimes four months. The delays are causing cash-flow troubles.

The safety net clinic in Hutchinson is having the same problems.

“We’ve noticed that each month we’re seeing more and more uninsured children,” said Kathy Ireland, chief operations officer at PrairieStar Health Center.

“We’ve been following up with parents to make sure they know about HealthWave or that they have to re-enroll if they’ve been on for a year,” Ireland said. “What they’re telling us is, ‘Oh, yeah, I did that two or three months ago, but I haven’t heard anything back.’”

Until the applications are approved or renewed, the children are uninsured.

HealthWave is the state’s health insurance program for children in low- and modest-income families. Depending on a family’s income, the child is covered through either Medicaid or the State Children’s Health Insurance Program, better known by its acronym, SCHIP.

Generally, Medicaid coverage is retroactive for up to three months before a family applies for HealthWave. SCHIP coverage is not retroactive; it begins when the child is declared eligible.

HealthWave is the name Kansas uses for the combined programs.

Ireland said she wasn’t sure how much the delays in application processing were costing the clinic.

“It doesn’t seem to bother the parents so much because we keep providing the services — that’s our mission,” she said. “What they don’t seem to think about is that one trip to the hospital could wipe them out. The other thing is that it means less money for the clinic, which makes it harder to see the uninsured.”

HealthWave applications and renewals are supposed to be in and out of the Kansas Family Medical Clearinghouse in two to three weeks — six weeks at the most.

Reports from the Kansas Health Policy Authority, which oversees the clearinghouse, show that in August 2008, one application and one renewal had been at the clearinghouse more than 41 days.

By August this year, 1,417 applications and 2,096 renewals had been parked at the clearinghouse more than 41 days.

Last week, the clearinghouse had at least 15,527 HeathWave applications waiting to be processed and 3,740 had been in the system for more than 40 days.

No one at the health policy authority is surprised.

In a May 1 press release, the agency warned that “as many as 50,000 Kansans could be denied timely access to medical care in the months ahead unless the state provides additional resources to deal with the growing backlog of applications.”

The backlog coincided with thousands of Kansans being laid off, losing their health insurance, and realizing their children were eligible for HealthWave.

The warning was repeated in a May 4 letter sent to all 165 Kansas legislators.

Health policy authority officials asked lawmakers for an additional $1.5 million to hire enough workers to clear the backlog. Legislators, however, denied the request, citing revenue shortfalls.

Since then, health policy authority officials have found ways to hold off the projected 50,000-person backlog.

“After the fiscal year began, we identified unexpected resources and devoted them to (paying) overtime at the clearinghouse,” Andy Allison, executive director at the health policy authority, wrote in an e-mail to KHI News Service.

“We are very concerned about the backlog, but also pleased it is not as bad as we feared,” Allison wrote.

But from a safety-net clinic administrator’s perspective a 15,000-person backlog isn’t much better than 50,000-person backlog.

“When I look at that, I see 15,000 kids who ought to have health insurance and don’t,” Postai said. “I appreciate everything KHPA has done to get the number down to 15,000, but somewhere in all this discussion there’s a judgment taking place that says, ‘This is an acceptable amount, and that’s not an acceptable amount.’

“Well, I’m here to tell you 15,000 is not an acceptable amount,” she said. “It’s too many.”

Legislators said they weren’t sure what to make of the backlog.

“I don’t like it,” said Rep. Bob Bethell, R-Alden, former chairman of the House Social Services Budget Committee. “I get concerned when I hear there are individuals out there — in this instance, children — who are in need of services that we as a state have decided we’ll provide, but when they try to get those services, they can’t. That should not be happening.”

Bethell said he wondered if the backlog could have been avoided if the health policy authority had done more to cut its administrative costs.

“Just this week I got an e-mail from the secretary at SRS (Kansas Department of Social and Rehabilitation Services), letting me know they’re getting ready to cut some upper and middle management positions because they need more people on the front line,” Bethell said. “Maybe KHPA should take a lesson from SRS.”

SRS is expected to announce its plan for cutting administrators and adding frontline workers early next month, according to an agency spokesperson.

Bethell said he expects the backlog to fuel calls for stripping the health policy authority of its independence and making it part of the governor’s cabinet.

“Right now, it’s not controlled by the governor’s office,” he said, “and the only control the Legislature has is when it sets the budget. So there’s not much oversight, they’re just sort of out there.”

Rep. Jim Ward, D-Wichita, said the health policy authority, shouldn’t be blamed for the backlog.

“What I think we all need to realize is that when we cut budgets like we have, there are consequences,” he said. “We like to tell ourselves we can keep cutting and it really doesn’t hurt anybody, but that’s wrong. It does hurt.”

Ward is a member of the House Health and Human Service Committee and the Joint Committee on Health Policy Oversight.

-Dave Ranney is a staff writer for KHI News Service, which specializes in coverage of health issues facing Kansans. He can be reached at dranney@khi.org or at 785-233-5443, ext. 128.