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More Than 1.7 Million Consumers Still Wait For Medicaid Decisions


One reason that states such as New York and Washington have done better than others is that they modernized their Medicaid eligibility systems earlier than others, Dorn said.  Other states such as Kentucky made sure their state insurance exchange could transmit data smoothly to their Medicaid program.

Medicaid is the workhorse of the nation’s health system, providing coverage to about one in 5 Americans. Twenty-six states have expanded eligibility under the health law to everyone with incomes under 138 percent of the federal poverty level, or about $16,100 for an individual. But even states that did not expand the program have seen increased demand for coverage, as people who were previously eligible but not enrolled tried to sign up as a result of publicity around the new exchanges and requirements that most Americans have coverage.

Unlike applying for private insurance through the online marketplaces, which can be done only during a few months of the year, people can apply for Medicaid anytime.

While states are working through their backlogs, the next big test will come Nov. 15, when open enrollment for private plans resumes and spurs a surge in people applying for Medicaid. The enrollment system should be running smoother by then, most experts say.

Georgia Gets Applicant Data Only In May

For states that used the federal marketplace,, a major complication was the technical issues that kept the federal site from sending complete applicant data to the states. 

Georgia’s Medicaid agency said it began to get applications from the federal marketplace only in May, and many of them were missing key information.

Trish Riley, a former Maine health official and a member of a commission that advises Congress on Medicaid, said the problems underscore the continued differences in state capabilities and cultures. Ramping up for a surge in Medicaid enrollment can be a big change for states that for decades focused on reducing fraud and abuse.

“It’s hard to change that culture, said Riley, an adjunct professor of health policy at University of Southern Maine.

California — which expanded eligibility--has experienced problems because of the sheer number of applicants and that enrollment is being handled by 58 counties using different computer systems, Riley said. About half of the 900,000 pending applications were made in the last 45 days, said California Medicaid spokesman Tony Cava. “Some [applicants] have not responded yet to our requests for …information [such as income].  Technology issues have also contributed,” he said.

State Eligibility Reviews

The process has been further complicated by state eligibility reviews that have found many people ineligible who applied through the federal marketplace.  States were always expected to make final eligibility decisions, but that has taken longer in some places than anticipated.

Fri, Jun 06 2014

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