Medicaid sign-up glitch has states, U.S. scurrying

WASHINGTON - More than 100,000 Americans who applied for insurance through healthcare.gov and were told they are eligible for Medicaid or the Children’s Health Insurance Program remain unenrolled because of lingering software defects in the federal online marketplace, federal and state health officials said.


RELATED ARTICLE

http://www.arkansas…">Exchange tallies under estimates

To try to provide coverage to those people before they seek medical care, President Barack Obama’s administration has begun a barrage of phone calls in recent days in 21 states, advising those who applied that the quickest route to get into the programs is to start over at their states’ Medicaid agencies.

State officials, meanwhile, were racing to cope in various ways - some enrolling people based on imperfect data files they received from Washington, others mailing letters urging eligible people to contact the state to sign up.

The chaos is likely to prove temporary because state and federal officials are now trying hard to help people enroll and because the coverage can be made retroactive to the first of the year.

Still, the fact that some users learned on healthcare.gov that they could join the two programs but nonetheless are not enrolled is creating a problem for states and confusion for consumers. The situation also offers a glimpse into technical problems that persist with the federal computer system that underpins the new online health-insurance marketplace, more than a month after Obama administration officials announced that it had largely been fixed.

“It would be ideal if we didn’t have to go through this,” said Jeremiah Samples, assistant secretary for the West Virginia Department of Health and Human Resources, which is in the midst of mailing letters to 10,000 residents who federal records indicate are eligible under a Medicaid expansion, telling them to apply through a state Medicaid website. “For our consumers … when the system doesn’t work for them, it just adds unease.”

The Idaho Department of Health and Welfare has assembled a team of five workers to send letters to 6,000 individuals identified through federal records to urge them to submit applications to the state, according to spokesman Thomas Shanahan.

Agency officials and their mail contractor worked on New Year’s Day to prepare the materials so they could go out first thing Thursday morning, he added, and the Centers for Medicare and Medicaid Services, the agency responsible for the federal health exchange, has been making calls to those same households.

“I think people are resigned to the fact that we have a tremendous amount of work ahead of us in the next few months. It is not going to be easy,” Shanahan said. “But we have to get this right from the beginning or the frustration will continue.”

White House senior communications adviser Tara McGuinness said the issue “impacts a small fraction of Americans who will have access to health care from Medicaid.”

McGuinness noted that 3.9 million people around the country were found to be eligible for Medicaid or the Children’s Health Insurance Program on the state level during October and November, a figure that included new registrants and renewals. The more than 100,000 people who have not made it into the programs are out of nearly 270,000 who applied through healthcare.gov during that same period and were informed that they qualified for Medicaid or the Children’s Health Insurance Program.

“One hundred percent of those who are having issues are being contacted by us or the states,” McGuinness said. She also pointed out that some people might benefit from another part of the Patient Protection and Affordable Care Act that has just taken effect, which expands hospitals’ latitude to enroll certain patients in Medicaid for three months while they apply for the program.

The Medicaid problem affects two groups of people who have sought coverage through the new federal health-insurance exchange and been steered, based on income, toward the two public insurance programs instead of private health plans.

One group consists of consumers in the 26 states that have expanded their Medicaid programs whose new coverage should have begun on Jan. 1. The other is low-income people around the country who decided to apply during the past few months because federal law now requires most Americans to have health insurance.

The cause of the Medicaid problem is that a basic feature of healthcare.gov is not yet working.

In the federal insurance exchange, on which three dozen states rely, consumers who apply for coverage submit information about their income and the system then tells them whether they qualify for a federal subsidy to buy a private health plan or, alternatively, whether their income is low enough that they belong in Medicaid or the Children’s Health Insurance Program, public insurance programs that are a shared responsibility of the federal government and states.

For people qualifying for those programs, the system is intended to transfer their applications to a computer system in their states and enroll them automatically. Software defects are preventing that from happening, so those consumers have been told since the site’s Oct. 1 launch to contact their state Medicaid agencies. In recent weeks, the Centers for Medicare and Medicaid Services has been working with 10 states - chosen because their own computer systems were thought to be best able to receive the federal data - to test the automatic transfer and try to get it working.

Andrea Maresca, director of federal policy for the National Association of State Medicaid Directors, said Centers for Medicare and Medicaid Services officials have not told states when the computer system can be expected to start working as it should.

In addition to the Medicaid troubles, insurance industry officials have said the computer system is continuing to be unreliable in generating enrollment reports for health plans so that they know who their new customers are. And now that the coverage has taken effect over the past week, it has placed new focus on another defect in the federal system: Unlike ordinary insurance, the federal exchange cannot yet adjust coverage to account for changes in people’s lives, such as a new baby in a family or if people move.

Centers for Medicare and Medicaid Services spokesman Aaron Albright said agency officials “are currently working with insurers to find ways to make changing coverage easier while we develop an automated way for consumers to update their coverage directly” through the federal system.

Front Section, Pages 10 on 01/05/2014

Upcoming Events