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Medicaid enrollment may be surging—but not through healthcare.gov

October 24, 2013

    Dan Diamond, Managing Editor

    We know that most of the early enrollment in the state exchanges has been through Medicaid.

    And new numbers released on Thursday continue to bear that out. While Kentucky's reported that more than 26,000 people have gotten covered through Kynect, less than 20% have signed up for qualified health plans (QHPs) like Anthem Blue Cross and Blue Shield, Humana, and other private coverage.

    But in the 36 states that are counting on the federal government to run their exchanges? There’s no direct way to enroll in Medicaid via healthcare.gov, as Matt Salo of the National Association of Medicaid Directors explained when we spoke earlier this week.

    "The functionality … is non-existent," Salo said.

    State-based exchanges smooth the process

    To understand how the functionality should work, we'll take a step away from healthcare.gov and look at the state-based exchanges.

    • Let’s say an uninsured woman who makes $10,000 per year visits Washington state’s exchange website, creates an account, and begins the application process.
    • After her income and other personal information is verified and she’s deemed eligible for Medicaid, the state exchange website not only alerts her, but also can quickly transfer her account to Medicaid’s systems so she can be enrolled in the program.

    Why does it work so smoothly? Because states like Washington spent months setting up and integrating new IT systems, in order to ensure an easy account transfer between their exchange websites and Medicaid’s eligibility systems. That's helped speed processing time for Medicaid-eligible applications, and it's another reason why Medicaid enrollment is surging in most of the 15 states that run their own exchanges.

    Federal website doesn’t sync up with Medicaid agencies

    But let’s say that same woman lives in a state that relies on the federal exchange. Instead of seamlessly routing the woman’s completed, Medicaid-eligible account, the website will give her a message: Contact your state’s Medicaid agency—which means starting the application process all over again.

    Basically, the same process that existed before healthcare.gov.

    "Back in September, HHS said that this kind of account transfer wouldn’t be ready until Nov. 1, at the earliest," Salo said. And on Tuesday, the agency announced that the functionality was delayed again. (At Politico, Kyle Cheney has more on the logistics of the delay and what it could mean when HHS does try to flip the switch on transferring accounts from healthcare.gov to state Medicaid agencies.)

    But in the short term, it's another point of pique for officials trying to fix the troubled federal exchange. And a potential frustration spot for residents in the 36 states that rely on healthcare.gov, too.

    "Get[ting] kicked offline and have to start the process all over again...is a road bump for people who wanted to end up on Medicaid," Salo said. "It poses a hassle for the consumer, especially if they’ve been told over and over again that healthcare.gov is a one-stop shop, a Travelocity…and it turns out that’s not the case."

    How do health insurance exchanges work?

    Government officials often compare the exchanges to online travel sites like Expedia or Orbitz. But given that many exchange websites aren't fully functional yet, I find it helpful to picture a big box store.

    For more: Read our primer, or our white paper, for answers to eight key questions and implications for providers.

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