Pa. making ‘slow progress’ processing Medicaid applications sent through HealthCare.gov

A bit of progress is being made in Pennsylvania, when it comes to dealing with a backlog of Medicaid applications submitted through the federal website, HealthCare.gov. To date, the state has successfully processed 400 out of an estimated 50,000.

 

HealthCare.gov is where individuals in Pennsylvania and other states with federally run marketplaces can sign up for private health insurance under the Affordable Care Act. The site is also designed to assess whether a person qualifies for Medicaid and kick start that enrollment, regardless of whether that state has opted to expand Medicaid eligibility under the ACA.  Pennsylvania has not done that, but is pushing an alternative method of expanding coverage.

“The way that the account transfer should have worked is you would have gone onto HealthCare.gov, put in all of your information, and they would have said ‘you may be eligible for Medicaid, let me send you to Pennsylvania,'” explained Kait Gillis, a spokesperson with Pennsylvania’s Department of Public Welfare.

That’s the idea, but doing so assumes the federal site and each state’s unique Medicaid operations system are able to properly connect. And at least for Pennsylvania, the systems — COMPASS and HealthCare.gov — have had a lot of trouble talking to one another, if at all.

As a result, in November, officials with the Centers for Medicare and Medicaid Services, offered up applicant information to states through so-called ‘flat files,’ or excel spreadsheets, so states could in turn follow up with applicants directly while technical problems were being sorted out.

Pennsylvania declined, says Gillis, believing the issues would be resolved shortly. The files CMS offered also didn’t provide “sufficient information to accurately process these accounts.”

Meanwhile, certified application counselors such as Moshe Bitterman, with the Public Health Management Corporation in Philadelphia, suspected problems with Medicaid transfers early on, despite major improvements overall in HealthCare.gov. Tasked with helping people navigate the ACA enrollment process, he recalls trouble tracking applications supposedly referred to DPW through HealthCare.gov.

“If you follow up, they really had no record of the application,” said Bitterman.

Instead, at the urging of ACA assistance networks, he and others have since been helping anyone thought to be eligible for Medicaid apply directly through DPW.

By December, CMS started notifying about 20,000 Pennsylvanians, deemed potentially eligible for Medicaid through HealthCare.gov, to reapply for Medicaid directly through the state. DPW issued a consumer alert.

By mid-February, the state began accepting some of the applications, in waves, fully processing about two dozen out of the some 50,000 which had accumulated by that point, according to Gillis.

Now, CMS “is actively transferring accounts to all states that are ready to receive them,” said Emma Sandoe, a spokesperson for CMS, via email. “Some states are still finishing their development and testing, and we are actively working with them to enable transfers as quickly as possible.”

DPW has obtained a lot more of them — 22,000, to date, of those 50,000 — but many are missing essential information like social security numbers and income details, according to Gillis, by no fault of the applicants. So for applications to be complete, county workers are now charged with following up with applicants directly to confirm and fill in details.

Of those 22,000 transferred accounts, 14,000 have gone through the electronic acceptance system, says Gillis, and have in turn gone to those county assistance offices to be checked. Of those 14,000 applications, 400 have been fully processed and accepted into the state Medicaid system. Another 800 accounts were identified as already existing in DPW’s system.

“We are making progress,” says Gillis. “We’re moving in the right direction.”

Typically, the state processes Medicaid applications submitted directly through DPW within 30 days. Gillis doesn’t know how long it will take to process the accounts set up through healthcare.gov, but she says staff is working “as fast as humanly possible.”

Coverage kicks in retroactively, pegged to the date of the application. For applications submitted prior to January 1, 2014, however, coverage would be effective January 1, 2014.

CMS and DPW want anyone interested in signing up for Medicaid to apply directly through the state. That message may be resonating even through HealthCare.gov at this point: during an enrollment event Wednesday evening, Bitterman said one person informed him a Medicaid eligibility notice had popped up, when applying earlier through the federal marketplace, instructing individuals to directly apply for Medicaid through the state system.

Pennsylvania’s experience doesn’t appear universal.

In neighboring New Jersey, the state has reported some challenges with the Medicaid application transfers from the federal website, but according to Nicole Brossoie, with New Jersey’s Department of Human Services, 60,000 applications from healthcare.gov have been successfully processed and completed to date.

Disclosure: The Public Health Management Corporation supports WHYY’s health desk.

 This story is part of a partnership with NPR, WHYY and Kaiser Health News.