100K Not Enrolled in Medicaid, CHIP Because of HealthCare.gov Glitch
More than 100,000 U.S. residents who were deemed eligible for Medicaid or the Children's Health Insurance Program through HealthCare.gov have yet to be enrolled because of ongoing technical issues with the site, according to federal and state officials, the Washington Post reports.
At issue is a function of the site that is supposed to electronically send applications for those deemed eligible for the programs to their state's computer systems and automatically enroll them. About 3.9 million U.S. residents were found to be eligible for one of the two programs in October and November of 2013. Of those, 270,000 were deemed eligible through HealthCare.gov, which often failed to transfer the appropriate data.
In response, federal officials launched phone calls in 21 states, advising those who were deemed eligible to reapply directly through their state's Medicaid agency. CMS also has been working with 10 states to test and fix the automatic transfer function. Although progress has been slow, CMS on Friday was able to send 162 of 200 accounts for potential beneficiaries in New Mexico and successfully sent all 200 applications to Delaware.
Meanwhile, state health departments are working to contact eligible residents via mail, while five states are enrolling residents based on "flat files" sent by CMS, which contain basic information about people from the state who appear to be eligible for the programs.
For example, West Virginia Department of Health and Human Resources Assistant Secretary Jeremiah Samples said his department is mailing letters to 10,000 state residents who appear to be eligible for coverage under the Medicaid expansion, advising them to apply through the state's Medicaid website. Similarly, the Idaho Department of Health and Welfare created a team of five workers to contact 6,000 state residents via mail to submit their applications to the state, according to DHW spokesperson Thomas Shanahan.
Despite the confusion, White House spokesperson Tara McGuinness said she expects everyone to be enrolled shortly, noting, "One hundred percent of those who are having issues are being contacted by us or the states." According to the Post, the issue is not a major concern because once enrolled, the coverage can be made retroactive to Jan. 1 (Goldstein/Eilperin, Washington Post, 1/4).
Medicaid 'Churning' Causes Concern
In related news, state and federal officials are concerned that millions of U.S. residents who are expected to shift between the health insurance exchanges and Medicaid will suffer coverage gaps or inconsistent care, Kaiser Health News/Washington Post reports.
The issue, called "churning," is not a new phenomenon. However, the creation of the health insurance exchanges means that exchange patients who become eligible for Medicaid because of fluctuations in income levels could be moved to a Medicaid managed care plan run by a different company that has a different provider network.
Matthew Buettgens, a senior researcher analyst at the Urban Institute, estimated that nine million people will be subject to churning in 2014.
Jeff Myers, president of Medicaid Health Plans of America, described the situation as "serious" for patients' continuity of care and the stability of the marketplace.
Although there is no real way to eliminate the issue, states' priority will be to make the transitions as seamless as possible, according to the Post. Several states already have begun devising plans to address the problem. For example:
Delaware will require exchange plans to temporarily cover approved medical treatment and medications for those who transition from Medicaid;
Nevada in 2014 will require Medicaid managed care companies to offer a plan comparable to those on the exchanges; and
Washington state has created a program to help companies offering plans on the exchange to offer Medicaid plans.
In addition, Reps. Joe Barton (R-Texas) and Gene Green (D-Texas) have sponsored a bill that would require states to cover Medicaid beneficiaries for 12 months, as opposed to the current system which typically requires individuals re-apply every six or 12 months.
Although experts say requiring insurers to offer plans both through the exchanges and Medicaid would be the best solution to reduce churning, Association for Community Affiliated Plans CEO Margaret Murray said the differences between the two markets and state health rules pose barriers (Bergal, Kaiser Health News/Washington Post, 1/5).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.