Utah tackles backlog of 24,000 Medicaid applications
Health reform • The efforts continue but state programs still are unable to talk to HealthCare.gov, leaving 24,000 applicants in digital limbo.
Published: January 9, 2014 08:49PM
Updated: January 9, 2014 10:50PM

Utah is working to free 24,000 Medicaid applicants from digital limbo on the federal health insurance portal healthcare.gov.

It’s a slow, manual fix requiring eligibility specialists to pull applicants’ information from a spreadsheet provided by the feds and enter it by hand into the state Department of Workforce Services’ computerized eligibility system. And the solution is temporary.

The online health exchange is now synced and able to communicate directly with Utah’s eligibility system, said Workforce Services spokesman Nic Dunn. But the connection needs further testing before it can be relied upon to automatically process applications, he said.

Utah had hoped to test the connection prior to HealthCare.gov’s launch date on Oct. 1 and was ready to do so. But the feds, buried under Affordable Care Act deadlines and technical glitches, were not.

“We’re now playing catch-up,” said Dunn.

The federal exchange used by 36 states was designed to be a one-stop-shop for insurance, funneling consumers into full-priced and subsidized private health plans or the low-income program Medicaid. But some states, including Utah, wanted to retain control over Medicaid eligibility, which meant building data bridges between the exchange and states’ idiosyncratic eligibility systems.

Because those bridges are still under construction, tens-of-thousands of Americans have been deemed eligible for Medicaid or the Children’s Health Insurance Program (CHIP), but await final vetting of their applications by states. They should have been enrolled on Jan. 1.

“They’ve been waiting long enough so we want to work through the backlog of applications as quickly as possible,” said Kevin Burt, Workforce Services’ associate director of eligibility.

Burt’s team of caseworkers are now manually working through the first batch of about 12,500 applications backlogged from October and November. When they finish, hopefully by the end of next week, they’ll tackle a second batch of 11,500 who applied in December — but only if the data link isn’t fully functional, Burt said.

Utah’s system has been linked to the federal data hub for weeks, but the two systems aren’t talking.

“We’re doing payload testing to take data they send and pull it into our database, but we’re concerned ... because there’s a lot of duplicate applications and incomplete applications,” said Burt. “Nine states have tried this. I’m not aware of a state that has pulled [the data] seamlessly into their system in an automated fashion.”

States are also unable to transmit data to the federal hub, namely Medicaid denials. As a result, 1,600 Utahns who aren’t eligible for Medicaid but could qualify for heavily subsidized private insurance also are in a holding pattern.

Federal officials are working with navigators to troubleshoot individual cases.

“We started sending states flat files [containing detailed application information] last month. Some states have been able to handle them immediately,” said Mike Fierberg, a regional spokesman at CMS. “The situations are as different as the states are. We’re working with Utah Medicaid on a daily basis to work through the backlog and get people the insurance they need.”

The situation in Utah is complicated by its indecision over whether to expand Medicaid.

Burt fears many of the 24,000 Utahns waiting to enroll won’t be eligible. It’s possible that the exchange is assessing eligibility as if Utah had expanded, he said. “We don’t know.”

Utah already has “open files” on some applicants, possibly because they’ve applied in the past or gave up on the exchange and applied directly through Workforce Services. Burt expects to move through those applications quickly.

But some applications in the federal spreadsheet show missing information. Workforce Services will have to reach out to those applicants with a formal letter seeking more information, which will take more time, said Burt.

kstewart@sltrib.com

Twitter: @KStewart4Trib

Buying health insurance

Under the Affordable Care Act, almost all Americans must have health insurance coverage in 2014. The online insurance exchange HealthCare.gov will stay open for enrollment through March 31.

But state officials say Utahns who think they might qualify for Medicaid should consider applying directly through Utah’s Department of Workforce Services at www.jobs.utah.gov.

Need more help?

There are several options for those who need help shopping the Affordable Care Act’s online health exchange:

Go to www.takecareutah.org or call 211 to find the nearest trained navigator

Find a certified insurance broker near you at bit.ly/brokerfind

Online chat at healthcare.gov

Toll-free call center at 1-800-318-2596