Tag Archives: West Virginia

HIX: Some Medicaid Enrollment Issues Have Surfaced

By Tasia Hooper

More than 100,000 Medicaid eligible persons are still uninsured in at least 21 states.  These individuals have been identified as having applied, or attempted to apply, for coverage during October and November 2013 when the federal health exchange was experiencing technical issues. Twenty-one states are receiving phone calls from the Obama administration advising the fastest method to get these people enrolled is to start the application process over from the beginning with their own state Medicaid agency.  The 100,000 + failed applications do not include failed applications for December 2013.  That number has not yet been released.  White House Senior Communications office Tara McGuiness states that ‘100%’ of the people having issues with Medicaid enrollment are being contacted by the White House, CMS or by their own state’s Medicaid agency.

Technical issues between the federal exchange (not specifically identified issues) and the individual state Medicaid agencies continue to plague the enrollment effort. CMS is working with 10 states to test these enrollment issues.  Initially CMS planned to attempt sending enrollment records for 200 Medicaid eligible applicants to their respective state’s Medicaid agency.  This effort has since been reduced from 200 test cases per state to 50 cases, then 10 cases and in some instances even less than 10 records. Test results were mixed.  Some of these 10 states show records not arriving at all.  Some records that transmitted contained errors including but not limited to incorrect addresses.

Tennessee is a participant in this test program with CMS.  The first test attempt by CMS, in mid-December, showed a test transmission of 10 records.  Three records arrived.  Seven records never arrived and have never been located – literally these seven records disappeared.  Before Christmas CMS attempted another test with Tennessee.  Zero records were transmitted.

Delaware received 50% of their records from the initial CMS test.  

January testing attempts are proving to be more successful.  New Mexico received 162 of 200 records in a test performed on 1/3/2013.  Delaware received 100% of records sent in a similar test of 200 applications.

Private health plan officials continue to say the records transfer issue is not limited to Medicaid.  Unnamed officials maintain they are getting unreliable enrollment reports.

New Mexico had to contact 15, 361 persons regarding Medicaid enrollment failures.  New Mexico also found 45 names in their file from states other than New Mexico.

Utah is manually processing 24,000 records after the federal health exchange failed to send applications back to Utah for processing. 

Utah and New Mexico are set up in a similar manner.  Any New Mexico or Utah resident who qualifies for Medicaid through the federal exchange would have their record returned electronically to the states Medicaid agency for processing.  The federal data returned to the state was missing vital information such as incomplete social security numbers or incorrect addresses.

Maryland has at least 5,000 residents who have tried to enroll in coverage (Medicaid or Commercial) and find themselves with no coverage as of 1/1/2014.  Governor O’Malley has called for a temporary shift for coverage for these residents and is asking they be enrolled under the state’s health insurance program that was established in 2002 for high risk individuals with pre-existing conditions.  This shift in coverage has to be approved by the state legislature.

CMS has offered up contingency plans for the states where the Medicaid enrollment is missing.  CMS will allow the states to use flat files.  These flat files would not be a basis of enrollment, rather a ‘heads up’ to show the states what their potential eligibility will be once automated eligibility transfer begins.

Because of the ongoing issues with the automated eligibility transfers CMS opted to give the 26 states, where Medicaid expansion has occurred the option of solely relying on these flat files as enrollment.  Five of the 26 states accepted this option.

Even the flat file eligibility transfer shows issues.  West Virginia requires Medicaid members pay a portion of their medical care.  These flat files are missing the cost to the West Virginia patients. 

Pennsylvania sent a consumer alert on 12/31/2013 to advise people who had applied for Medicaid on the federal health exchange that they were not enrolled with coverage.  The alert advised telephone calls would be made instructing them to apply directly to the Pennsylvania Department of Public Welfare.  Approximately 25,000 people were affected.

Alabama and Nebraska are relying 100% on CMS to advise Medicaid enrollees to go through their respective state agencies.

New defects noted in recent articles shows that the federal exchange still cannot adjust to changes in a person’s life – example a new baby, new address.  CMS maintains they are still working through all outstanding issues.  CMS further states they are still trying to develop an automated way for the consumer to update their coverage directly through the federal health exchange.