A recent webinar from the Kansas City Medical Society Foundation titled, “Let’s Talk KanCare: What Every Kansan Should Know about Medicaid Expansion” explored the mystery surrounding Kansas’s eligibility requirements for Medicaid. Currently, 165,000 Kansans are left out of coverage due to seemingly nonsensical requirements, leaving many unable to receive necessary care or burdened with debt. Panelists outlined the specific issues with the current eligibility limit, as well as how KanCare can reduce health care costs for everyone and protect Kansans from medical debt.

The webinar panel included April Holman, Molly Gotobed, and Karole Bradford, moderated by El Centro’s Erica Andrade. Holman serves as the Executive Director of Alliance for a Healthy Kansas, an organization leading the work for expanding KanCare through education and personal stories. Gotobed is the Program Director with the Community Health Council of Wyandotte County. Through her program Kansas Assistance Network, Gotobed helps communities directly with Medicaid and marketplace applications, as well as finding health and social care services. As part of the Kansas City Medical Society Foundation, a health care partner of the webinar, Bradford works on issues of health equity and access, including work with Alliance for a Healthy Kansas.

Fixing the Eligibility Limit

To understand the benefits of KanCare, it’s important to first understand who is currently being left out of coverage due to eligibility requirements. In Kansas, those who qualify for Medicaid include people who are:

  • Pregnant.
  • Responsible for a child 18 years of age or younger.
  • Blind or have a disability or a family member in your household with a disability.
  • 65 years of age or older.

To be eligible for Medicaid, individuals must also meet annual household income requirements, which are dependent on household size.

According to Gotobed, one key point is consistently lost among conversations about Medicaid expansion — yes, she and other organizations receive referrals to assist people in need, but unfortunately many of them don’t qualify. In the month of April alone, she has received several referrals for people who are ill and need specialty care, who can’t work because of their illness, and can’t get the care they need because they don’t meet eligibility requirements for one reason or another.

Currently, a parent with one child has to earn less than $600 per month to qualify for Kansas Medicaid. A family of three has to earn $730 or less per month. Many people, especially those with an injury or chronic illness, are consequently not incentivized to work so they can remain under the earning limit.

“Folks without kids who are very ill or have an injury that they need taken care of, even if they have no income, they don’t qualify,” she said. “That is heartbreaking.” In her experience, many people become sick or injured and believe they’ll be able to sign up for Medicaid, without understanding the limits in place. This often includes part-time workers who are especially at risk because they make too much to qualify for assistance but also aren’t earning high wages.

“We see this time and time again and I think there’s a big misunderstanding among the public and the medical professionals about who can qualify for this,” she said. “They want to work. Majority of these people want some type of health care so they can go to the doctor and get better – but there’s nothing we can do about it.”

According to Gotobed, severe illnesses, such as a terminal disease or a stage four organ failure, can fast-track the disability process. Unfortunately, many people don’t receive necessary care until they’re in this position. However, to do so requires access to preventive care and potentially specialists, which require insurance.

“We see a lot of folks who have illnesses that could have been made better, and eventually they’re just debilitating, or the person becomes deceased because they were not able to get the care they needed,” she said. “It’s incredibly sad and I just want to drive home that it doesn’t matter if you have no income and you’re super sick – if you don’t meet the eligibility requirements in Kansas, you cannot get Medicaid. That’s who is in the gap.”

Protecting Kansans from Medical Debt

Although some Kansans delay care until they meet eligibility requirements, many people simply avoid care to avoid the pricey medical bill. According to an overview of data provided by Holman, medical debt rates are much higher in states that haven’t expanded Medicaid, creating concerns for both community health and overall financial stability. People in non-expansion states owe an average of $375 more in medical debt than people in expansion states. In Kansas, nearly half of Kansans struggle with the burden of medical debt or know somebody close to them who does.

Additionally, about 18% of Kansans have medical debt that has reached the point of being in collections. People with disabilities, people who are in worse health, and people who are poor or near poor are more likely to owe significant medical debt than other Americans. Medical debt is also worse for people of color, affecting about 28% of Black households, 22% of Latino households, and 18% of white households.

“You can see that it’s an issue across the board, but also something that is a little bit harder for our neighbors of color,” Holman said. “Legal debt collection actions are more frequent within communities of color and Black people in particular are more frequently subjected to lawsuits over unpaid medical bills with liens put on their homes and bank accounts and wages garnished.”

Overall, unpaid medical debt is the largest source of debt owed across the country, exacerbated especially in states like Kansas that have not yet expanded Medicaid eligibility. Holman believes this is a problem for two major reasons: health issues continuing to go untreated, and the impact on community financial stability.

Too often, chronic health issues go untreated due to exorbitant drug prescriptions and health care costs. According to Holman, we know that:

  • Many people with medical bill problems report delaying or skipping health care over the past year because of the cost at rates two to three times that of their counterparts who did not have problems paying medical bills.
  • 43% of people with medical bill problems say that there was a time last year when they or a family member did not get a recommended medical test or treatment because of the cost, compared to just 13% of those without medical bill problems.
  • About 41% of people who faced medical bill problems reported not filling a prescription in the last 12 months because of the cost, compared to only 14% of people who did not have medical bill problems.

Medical debt has broad-reaching repercussions for family financial security and can make it difficult to own a home, maintain reliable transportation, and cover utility costs. People with medical debt report cutting spending on food, clothing, and other household items, spending down their savings to pay for medical bills, and borrowing money from friends and family members, or taking on additional debt, to take care of medical debt.

“The bottom line is that KanCare expansion would help more low-age people obtain coverage so they can avoid going into that medical debt in the first place,” Holman said. “It would help them to receive the care and treatment they need to maintain good health and financial stability.”

KanCare: Reducing Costs for Everyone

KanCare proposes to address the growing concern of medical debt for Kansans by picking up the tab on uncompensated care. Currently, every part of the health care system – hospitals, pharmacies, clinics, private practices, drug practices, and more – provide uncompensated care. Some costs are the patient’s responsibility, who often are the people least likely to be able to afford it. The cost of medical debt, especially unpaid, can then affect access to housing and necessities.

According to Bradford, another portion of uncompensated care costs is simply eaten by hospitals and other care facilities. “This is why in Kansas we have 70 some hospitals at immediate or elevated risk of closure because they ate that uncompensated care cost,” she said. “Especially in rural areas, some of that cost is then going to get passed onto the municipalities, the cities and counties, that pay for community hospitals.” And who pays the cost for municipalities? The taxpayers.

“All of us, whenever we’re paying any doctor bill or an insurance bill, all of us are eating that cost,” Bradford said. “It also gets passed onto the vendors in increased costs for labs, medications, treatments, and they similarly get passed on to insurance companies, they get passed onto municipalities, they get passed onto taxpayers, they get passed onto bill payers.”

Beyond relieving the individual burdens placed on families and taxpayers alike, KanCare has the potential to improve health care delivery on a community-wide level. According to Gotobed, if clients are less reliant upon emergency and uncompensated services, more preventive services could be provided and even expanded upon. The result would be more access to preventive services and specialty care, especially in communities currently in need, and the ability to drive dollars to underfunded programs and expansions.

“There are a lot of problems with our health care delivery system, not just in Kansas but across the country, and having expansion as a payment source in Kansas would really help us to be more innovative and potentially address some of the other issues that are out there with those dollars that are now going to pay for the types of ways that we try to cover people in the gap but don’t quite make it,” added Holman. “I think that money would go to use in other ways.”

Changing the Conversation

Earlier polls conducted by the webinar partners found that overwhelmingly, Kansans support KanCare expansion – with one exception. There is a clear lack of understanding of the facts of the program, often leading to confusion and misinformation within conversations about Kansas Medicaid and KanCare. During a breakout session of the webinar focused on fixing the eligibility limits, Gotobed and several attendees shared personal experiences of navigating the complicated topic.

“People are just in disbelief,” Gotobed said. “They’re like, ‘Well I’m poor, but I’m not poor enough.” When clients ask for guidance, she tries to connect them with someone to help navigate what little resources are available, such as a clinic or a community health worker. In some cases, she and the client determine if there is an option to work more hours or even get married to have a joint income and be able to meet the income requirement. “It’s very sad that that’s where we’re at right now,” she said. “I have folks who have life-saving medications that they have to have and they just cannot get because they don’t qualify for anything.”

One attendee mentioned that in her work with Cover Kansas, she learned about a new special enrollment period, advertising that they accept anyone up to 150% above the federal poverty level. However, people in states without expanded Medicaid quickly become frustrated to learn the limits are actually 100-150% of the federal poverty level, once again overlooking them in the health care gap.

In a clear consensus, attendees agreed that in their experience, people think their failure to understand Kansas Medicaid requirements is an individual failure – that they are the only ones confused, or that they must be missing something.

Another attendee pointed out that overall, people simply don’t understand because it doesn’t make sense. This may then interfere with their decision to vote or advocate for Medicaid, even if they would be in support. “It makes so little sense that people don’t even understand it and think they must be confused and so they just don’t take the issue on or advocate for it because it’s so confusing, it feels like, ‘That can’t be,’” she said.

To combat this, it’s crucial to change the conversation surrounding KanCare. The Kansas legislature is currently wrapping up their session on this issue without a single hearing. Rather than focus on individual conversations to and with legislature members, the focus must now be on elevating community voices as a whole.

“I think the messaging must be focused on our community members, on other people in our community who may know and feel the same things you do but may not feel empowered to speak up,” Bradford said. “Part of this challenge is for each of us to learn to speak in our own way so that we can be the voice in the wilderness, so we can be our own choir. Because we can each be empowered, we can each empower others.”

Panelists recommend talking to those in your network – family, friends, peers, coworkers – both formally and informally to inform them about the facts and benefits of KanCare and get them talking to their own circles. “The only way that we’re going to expand KanCare is to expand the conversation,” Andrade said.

Andrade also recommends reaching out to state officials and asking about their stance on KanCare. If they do support expansion, ask why – is there a messaging point or personal narrative that has been missed by others? If they don’t support expansion, listen to understand their stance, and examine how to shape future conversations to address any previously unmet hurdles.

The League of Women Voters offers a tool to find your representatives and their contact information.

Alliance for a Healthy Kansas is currently leading the charge on KanCare expansion. Sign up for email updates with personal narratives, upcoming events, and more information to keep this conversation going.