Individuals and families must meet a variety of eligibility requirements to qualify for Medicaid services. In order to ensure that members continue to meet the requirements, the eligibility of each member is re-determined once a year. Re-determinations occur on a state level, but the requirement for states to complete annual financial reviews is a mandate from the Centers for Medicare and Medicaid Services (CMS). Re-determinations are completed on a continual basis throughout the year, with each member up for re-determination one year after they were last determined eligible for services.

The Kansas Department of Health and Environment (KDHE) utilizes two types of renewals in re-determinations:

Passive Renewals. Passive renewals, also known as auto renewal or ex parte renewals, require no additional action by the member if the information is correct. These renewals occur when KDHE is able to match all eligibility criteria, such as income, against existing data sources. KDHE staff sends the household a letter with the information found and the member only needs to respond if information is not correct; and

Pre-populated Renewals. Pre-populated renewals occur when KDHE is not able to electronically match required eligibility to existing data sources for each member in the household. Any member who does not meet the criteria has to respond to the request for information. In these cases, the system will populate the member’s renewal form with any information they were able to verify and send it to the member in the family who does not meet the criteria to complete. The member is then responsible for completing the form and returning it to KDHE for processing. This results in some members of the household receiving a passive renewal and other members required to respond to KDHE.

All renewals start as passive renewals but become pre-populated renewals when data is not available or it is significantly different than what is currently in the system. Members have approximately 90 days to submit the renewal, which can be completed on paper or online. Renewal forms must be signed and received by the KanCare Clearinghouse timely for the review process to complete.

If the member returns their pre-populated renewal by the deadline, they will stay on Medicaid until a final eligibility determination is made. If a renewal is returned late, the member will lose eligibility. However, if the deadline is missed, members have 90 days to submit the renewal and, if determined eligible, will have eligibility backdated. This is referred to as the “90-day window.”

Medicaid Unwinding

For the past three years, federal law has required states to keep Medicaid members enrolled because of the COVID-19 public health emergency. During that time, Kansas Medicaid (KanCare) did not complete annual re-determinations. Instead, each member’s eligibility was retained without verifying renewal eligibility. This is often referred to as the “continuous eligibility requirement.” As a result, Medicaid enrollment increased from 410,000 to 540,000 members between March 2020 and April 2023.

In December 2022, the federal Consolidated Appropriations Act set April 1, 2023, as the end of the continuous eligibility requirement and states were required to resume re-determinations. This process is referred to as “unwinding.”

Kansas began its unwinding period in March 2023 with members who had an April renewal date. The unwinding process will take place over a 12-month period, with final renewal notices of the unwinding period being sent out in February 2024.

2023 Changes to Medicaid Re-determinations

During the process of unwinding, CMS provided technical assistance to Kansas and a correction was identified that impacts the passive renewal process for households.

When reviewing eligibility of members in the same household, data matches are applied to each person to determine if they meet Medicaid eligibility. Under previous practices, a pre-populated renewal was sent to all members of a household if any of the members did not qualify for a passive review. Under new practices, the pre-populated review is only sent to those individuals who do not meet the criteria for a passive review, and any household members who do qualify for a passive review will be sent a passive renewal form. This change is anticipated to increase the average number of passive reviews each month by 8.0 percent.

Another change made during the unwinding process is the extension of the time members have to return their renewal form. To cut down on the number of forms coming in late due to slower mail process, the original 30-day deadline to return renewal forms was extended to 90 days.

The Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022, or PACT Act, was signed into law by President Joe Biden on August 10, 2022. The Act expands eligibility for U.S. Department of Veterans’ Administration (VA) health care for veterans with conditions related to toxic exposures, as well as for certain combat veterans who left the military without enrolling in VA health care.

Presumptive Conditions Related to Toxic Exposures

Prior to the passage of the Act, veterans with disability claims arising from toxic exposures were frequently denied. Now, 11 types of cancer and 12 illnesses are considered presumptive conditions, meaning a veteran claiming disability due to one of these conditions does not have to prove military service caused the condition.
The Act requires the VA to provide a toxic exposure screening to every veteran enrolled in VA health care.

New VA Health Care Enrollees

The Act allows veterans who deployed to a combat zone, never enrolled in VA health care, and left the military between September 11, 2001, and October 1, 2013, to enroll directly in VA health care without first applying for disability benefits. The enrollment period for this special population ended on September 30, 2023.

PACT Act By the Numbers

The VA updates the PACT Act Performance Dashboard every other Friday to measure the implementation of the legislation. Figures issued on January 5, 2024, state that 665,775 total claims have been approved, and 223,934 people from the PACT Act special population have enrolled in VA health care. In addition, 5,078,680 veterans have received toxic exposure screenings since September 2022.

Kansas Statistics

In Kansas Congressional District (CD) 1, 3,229 total PACT Act claims were received between August 10, 2022, and December 30, 2023. CD 1 has a projected veteran population of 41,732. Statistics for the other CDs are as follows:

• In CD 2, 4,042 claims were received, with a veteran population of 54,344.
• In CD 3, 1,688 claims were received, with a veteran population of 39,146.
• In CD 4, 3,331 claims were received, with a veteran population of 46, 898.

KCVAO Veterans’ Claims Assistance Statistics

The Kansas Commission on Veterans Affairs Office (KCVAO) regularly assists veterans in submitting claims for benefits to the VA. The KCVAO states that in state fiscal year (FY) 2022, their veterans’ service representatives assisted in submitting over 10,500 new claims on behalf of veterans in Kansas, resulting in $295.5 million being awarded to veterans. In FY 2023, the number of claims submitted by KCVAO increased by 4,258, or 40.5 percent, above the number of claims submitted in the previous fiscal year. This resulted in more than 14,750 new claims being submitted on behalf of veterans, and more than $273.4 million being paid to Kansas veterans in FY 2023. Although there was a decrease in the monetary value of claims awarded, the increase in the number of claims submitted is attributable to the expansion of the PACT Act, according to KCVAO.

The United States’ population is aging at a rapid pace, and it is projected that this aging population will require the assistance of caregivers to help with a range of needs. In addition, society is facing a population reconfiguration that may require a shift of societal resources. McKinsey & Company calculated that “In 1950, for every person over the age of 65, there were 11.7 working-age people. Today, there are 7, and this is expected to shrink to 4.4 by 2040.”

The Aging Population

The U.S. Census Bureau projects that older adults will outnumber children by 2034, meaning 23.4 percent of the American population will be at least 65 years of age or older and 19.8 percent of the American population will be children under 18. In 2020, there were 490,390 Kansans, or 16.7 percent of the Kansas population, who were older than or equal to age 65. Centenarians (people aged 100 years or older) are the fastest growing age group, and they are expected to number 1 million in the United States by 2050 (PDF).

Caregivers

A caregiver is defined by the Merriam-Webster Online Dictionary as “a person who provides direct care (as for children, elderly people, or the chronically ill).”

The most recent Centers for Disease Control and Prevention (CDC) statistics indicate that 1 in 5 Kansas adults are caregivers. Caregivers are 40 percent men, 60 percent women; 25 percent are 65 years or older; 34 percent are caring for a parent or parent-in-law; and 9 percent are providing care to someone with dementia. Caregiving is usually a lengthy time commitment, with more than half of caregivers providing care for at least two years. The role is also intense, with 25 percent of caregivers providing at least 20 hours of caregiving each week. A majority of caregivers (80 percent) manage household tasks, and at least 50 percent of caregivers assist with personal care.

Value of Caregiving

In March 2021, the Bureau of Labor Statistics used data from two surveys to conclude the following, in part: “For older Americans and for Americans who are living with a chronic illness or a disability, informal caregiving can make an important difference between living independently at home and living in a nursing home. Often, informal care is provided by adults in midlife with many demands on their time.”

In October 2021, McKinsey & Company published an interview in which they indicated that “prepandemic, it was already estimated that unpaid caregivers were providing value to the US economy to the tune of $3.2 trillion. A more recent study pinned the spending of care-related activities as high as $648 billion, making it a larger economy than pharmaceuticals.”

The Problem Gambling and Addictions Grant Fund (PGAGF) is designed to support programs to address problem gambling and other addictions. The fund is administered by the Kansas Department for Aging and Disability Services (KDADS), with revenue collected from traditional lottery, casino gaming, and sports wagering.

Background

The “Problem Gambling Grants Fund” was created by 2000 Sub. for HB 2013 (bingo). The bill directed $80,000 of traditional lottery receipts and $20,000 of state bingo regulation receipts be credited to the fund. The grant program created by the bill was to provide assistance for individuals diagnosed as suffering from pathological gambling and to fund research regarding the impact of gambling on Kansans. The bill further authorized the administering agency to receive grants, gifts, contributions, or bequests for such purposes.

2007 SB 66 (casino gaming) renamed the fund to the PGAGF and directed 2.0 percent of the state proceeds from casino gaming to be transferred to the PGAGF annually. The bill also expanded the purpose of the fund to include programs to treat alcoholism, drug abuse, and other abusive behaviors.

2022 House Sub. for SB 84 (sports wagering) made the following changes to PGAGF revenue:

• Increased the annual transfer from traditional lottery receipts from $80,000 to $100,000.
• Provided that 2.0 percent of the State’s proceeds from sports wagering be credited to the PGAGF annually.
• Amended and added new PGAGF fund expenditure requirements that the funds be spent on the treatment, research, education, and prevention of pathological gambling, and funding a text message or chat helpline before authorizing expenditures to treat alcoholism, drug abuse, or other addictive behaviors and other co-occurring disorders.

Revenue to the PGAGF

Revenue to the PGAGF is based on lottery revenues, which are estimated every spring and fall as part of the Consensus Revenue Estimate (CRE) process.

For FY 2024, the Kansas Lottery estimates the following revenue to the PGAGF based on the Spring 2023 CRE estimates:

Expenditures from the PGAGF

Expenditures from the PGAGF are categorized as follows:

Medicaid Mental Health Expenditures. The KanCare Managed Care Organizations (MCO) contract with community mental health providers, including community mental health centers and private practitioners, to provide mental health services throughout the state, including alcohol and drug abuse treatment. In FY 2023, PGAGF funds provided 3.3 percent of the State’s contribution for Medicaid mental health expenditures.

Problem Gambling Services. These expenditures are made to third parties to support efforts to prevent problem gambling. In FY 2024, this amount was temporarily increased by $1.0 million to combat problem gambling due to sports wagering.

Administration. KDADS uses a portion of the PGAGF funds to fund 4.0 full-time equivalent (FTE) positions dedicated to supporting problem gambling prevention efforts.
Addiction and Prevention Services Grants. These grants are made to third-party providers to further the purposes of the PGAGF.

Historic Transfers

Historically, $700,000 was transferred annually from the PGAGF to the Governor’s Office for the Domestic Violence Grant Fund and Children’s Advocacy Center Grants Fund. Additionally, $500,000 was transferred to the Department of Corrections for the Community Corrections drug treatment program. These transfers were eliminated beginning in FY 2024.

For FY 2024, KDADS requests the following expenditures from the fund: