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More Than 1.7 Million Consumers Still Wait For Medicaid Decisions

WebMD News from Kaiser Health News

By Phil Galewitz

Fri, Jun 06 2014

While an unprecedented 6 million people have gained Medicaid coverage since September, mostly as a result of the Affordable Care Act, more than 1.7 million more are still waiting for their applications to be processed—with some stuck in limbo for as long as eight months, according to officials in 15 large states.

The scope of the problem varies widely. California, the most populous state to implement the health law’s expansion of Medicaid, accounts for a lion’s share of the backlog with 900,000 applications still pending as of early June. The next biggest pileup is in Illinois, with 283,000 cases, while New York has no backlog at all.

Yet even some big states that chose not to expand  the federal-state program for the poor, are seeing backlogs, including North Carolina with 170,000 applications pending, Georgia, with 100,000 and South Carolina with 62,000. Florida and Texas, which also did not expand the program, each report fewer than 11,000 in queues. Federal regulations typically require states to process applications within 45 days and many state applications are still within that period.

“It’s a serious problem that people are waiting a long time and the process of getting covered is more cumbersome than it should be,” said Stan Dorn, senior fellow with the nonpartisan Urban Institute.

Federal and state officials say the delays should not hamper people’s ability to get health care because Medicaid coverage can be extended retroactively for three months and people can seek emergency care at hospitals.

But Dorn said that some providers may refuse to see patients until they have confirmation they have insurance coverage. And without insurance, patients may not have cash to pay doctors who demand it upfront.

“You will have impaired access to care … because often the provider will not see you if you do not have a Medicaid card,” Dorn said.

The waits also contradict the administration’s promise that the online insurance marketplaces would bring a “no wrong door” approach to signing up for health care, regardless of a person’s income.

The reasons for the problems include technological glitches that prevented the federal insurance marketplace from transferring data on applicants to state Medicaid agencies and many states’ inability to handle an enrollment surge because of inadequate staffing, their own computer problems and other issues.

Feds Say They Are Making Headway

Officials at the Centers for Medicare & Medicaid Services (CMS) say they have made progress and can now quickly transfer data on applicants to all but three states — Alaska, Kansas and Maine — one reason that enrollment in the program surged by 1.1 million people in April.

The agency “is actively transferring accounts to all states that are ready to receive them,” said spokesman Aaron Albright. “Every state not receiving transfers can be enrolling people through alternative options,” such as getting a spreadsheet of names and addresses of people who have applied to the federal marketplace, he said.

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