The pace of enrollment in Arkansas’ expanded Medicaid program slowed last week, with just 450 applicants completing the process, compared with 3,625 the week before, a spokesman for the Arkansas Department of Human Services said Tuesday.

In all, 14,529 newly eligible adults - out of an estimated 250,000 - have been added to the Medicaid program since the Oct. 1 start of the enrollment period.

The expansion, authorized under the federal health-care overhaul law, extended eligibility for the program to adults with incomes of up to 138 percent of the federal poverty level - $15,860 for an individual or $32,500 for a family of four.

Most of those who are eligible are expected to be able to sign up for a private plan on Arkansas’ health-insurance exchange and have the premium paid by Medicaid, while about 10 percent - those determined to be “ medically frail” - are expected to be assigned to the traditional Medicaid program because of their health needs. Coverage will start Jan. 1.

So far, all of those who have completed enrollment have been recipients of the Supplemental Nutrition Assistance Program, also known as food stamps, who received letters last month notifying them of their eligibility for Medicaid under the expansion of the insurance program approved by the Legislature this year.

The department sent letters to more than 145,000 food-stamp recipients notifying them of their eligibility for Medicaid. As of Saturday, 65,138 recipients had sent back responses indicating they want to enroll.

However, most of those who responded to the initial letter have not yet responded to a second letter directing them to a state website, insureark.org, where they can complete the enrollment process.

At the website, applicants are asked to fill out a questionnaire meant to identify those people considered medically frail because of their exceptional health needs and who would be better served by the traditional Medicaid program.

Those not considered medically frail can complete enrollment on insureark.org by choosing a private plan.

Of those who have completed enrollment on the state website, 4,121 - about 28 percent of the total - were found to be medically frail. Of the 10,408 who were not found to be medically frail, 8,418 signed up for coverage in a private plan.

Applicants who are found to be eligible but fail to complete enrollment by visiting insureark.org within 12 days will be automatically assigned to a private plan, Human Services Department spokesman Amy Webb said. Enrollees who want to switch plans will then have 30 days to do so before being locked into the plan for the year.

The department expects to make the first round of automatic assignments next week, Webb said.

“Since this is the first time people are being asked to go through this process, we want to give them additional time to log on to the website and take the health needs screener,” Webb said. “We also want to make sure this is a smooth process for us, the insurance carriers and the people who will be receiving coverage.”

In addition to the food stamp recipients, 3,672 people have submitted applications through another state website, access.arkansas.gov, and 1,785 have applied over the phone or submitted paper applications.

From Oct. 20 through Saturday, the department received a total of 4,501 applications, including responses from food stamp recipients, compared with 9,806 the previous week. The new applications took the total to 70,595.

Applicants also can begin enrollment through healthcare. gov, the federal Web portal for enrollment in health-insurance exchanges in Arkansas and 35 other states.

The department has not yet been notified of any applications received through the federal website, Webb said.

She said the department isn’t concerned about the dip last week in completed enrollments and applications.

“We don’t expect there to be exactly the same number every week,” she said. “They can go up and down. I’m sure some weeks we’ll get more than others.”

Echoing comments last week by Sen. Jonathan Dismang, one of the sponsors of the legislation authorizing the expansion of Medicaid under the so-called private option, Rep. John Burris, another sponsor of the legislation, said Tuesday that problems with the federal site have hampered enrollment in the Medicaid program.

The success of the private option and the subsidized insurance plans being offered under the Patient Protection and Affordable Care Act depend on a large number of people - and not just those with costly medical expenses - signing up, he said.

“It’s not too much to say that the wheels are not off the bus, but they’re wobbling, and they’re losing critical time daily,” Burris, R-Harrison, said.

The U.S. Department of Health and Human Services’ Centers for Medicare and Medicaid Services, which operates the federal portal, has said it plans to release numbers on enrollment through the federal website next month.

During a conference call with reporters Tuesday, Centers for Medicare and Medicaid Services spokesman Julie Bataille said the agency had made enhancements to the website meant to reduce the number of errors users encounter while attempting to create an account - a step required before a user can shop for coverage on the site.

Acknowledging that the step had been a source of “a lot of frustration” for users, Bataille said the improvements allowed the site to handle 17,000 registrations per hour - or about five per second - with “almost no error rates.”

“We believe we have stabilized the account creation process,” Bataille said.

On Tuesday afternoon, an Arkansas Democrat-Gazette reporter was able to create on account on the site before landing on a page with a message saying the system for verifying eligibility for subsidies was “temporarily unavailable.”

“Obviously the technical problems that have been associated with the [federal] website have been an obstacle for those folks who want want to apply that way,” Webb said. “Our hope is that the issues will be resolved soon, and people who want to apply through that approach will be able to get through the process.”

In addition to allowing people to apply for Medicaid, the intended purposes of the federal site include allowing people to apply for federal tax-credit subsidies to help them buy coverage in the private plans.

The tax-credit subsidies are available to those who do not qualify for Medicaid or other public insurance programs and have with incomes below 400 percent of the poverty level - $45,960 for an individual or $94,200 for a family of four.

Outreach workers with the Central Arkansas Library System, hired under a contract with the state Insurance Department, have had “sporadic” success in using the federal website to help people enroll, said Jennifer Chilcoat, the system’s head of human resources.

That’s an improvement compared with a few weeks ago, she said, when “nobody was able to get on.”

She said the workers, stationed at two locations in Little Rock - the Main Library and the Hillary Rodham Clinton Children’s Library & Learning Center - and two or three other branches each day, have been helping 15 to 20 people per day. When the website isn’t working, the workers help people fill out paper applications or apply over the phone, Chilcoat said.

Pam Christie, director of the Mental Health Council of Arkansas, said her organization’s outreach workers have been encouraging people to learn about their options, including by visiting the federal website.

“Now’s a good time for people to educate themselves, so that when you can jump in there, you’re ready to do that,” Christie said.

Front Section, Pages 1 on 10/30/2013