Will the Medicaid expansion be smoother than the exchange rollout?

NAMD: State Medicaid directors are 'flying blind'

Topics: Reimbursement, Finance, Medicaid, Information Technology, IT Infrastructure, Health Policy, Market Trends, Strategy

October 25, 2013

The Affordable Care Act's (ACA) federally run exchange is supposed to start transferring Medicaid applications to state agencies next month, but officials warn the transfer system has hardly been tested, Politico's Kyle Cheney reports.

On Nov. 1, ACA's "glitchy" Healthcare.gov portal is supposed to send reams of data to state Medicaid programs so they can open enrollment and begin the process of expanding Medicaid in states using the federal exchange. That date was already postponed once, from Oct. 1, creating confusion for some people attempting to enroll in Medicaid.

  • ACA 'coverage expansion' starts next year—but what does that mean? Our 2014 rollout primer explains the changes slated for health care next year.

Delay in Medicaid application transfers causes confusion

Kathleen Nolan of the National Association of Medicaid Directors (NAMD) says some individuals have managed to sign up on Healthcare.gov, but were then directed to their local Medicaid agencies to finalize the process.

However, local Medicaid offices have not yet received applications and thus cannot confirm enrollment. "People are getting a little confused," Nolan says.

System may not be ready on Nov. 1

State officials say the transfer system still has barely been tested and could be vulnerable to the same technical problems that have plagued the exchange website.  

"We're flying blind on what the process is," says Nolan, adding, "There's a natural concern that with a major load of data to be sent all at once—there is concern that what has been tested may not be able to handle the volume."

Although the Obama administration has delivered a basic snapshot of Medicaid-eligible individuals to help states get a sense of numbers, the information includes only names and addresses—not nearly enough to begin processing applications.

CMS Administrator Marilyn Tavenner in a conference call with states Tuesday did not offer a timeframe for a full repair of the transfer system, according to NAMD Executive Director Matt Salo.

Some Medicaid experts believe the transfer will be delayed past Nov. 1. The federal government "cannot afford to dump bad data on the states, and it would waste precious time," says former CMS advisor Kip Piper, adding, "Perhaps they will take a more baby step on Nov. 1, allowing states to accept a small number of files and run them through their eligibility systems."

Health consultant Dennis Smith anticipates "a lot of double-checking" of the files after all the issues with the federal portal. Any further delay could leave some individuals without coverage on Jan. 1, he warns, because states can take up to 45 days to review applications. In the short run, he noted that people can sign up for Medicaid directly through the state to ease pressure on the federal enrollment system.

Until then, state Medicaid directors cannot do much to prepare for Nov. 1—other than wait for the federal government to hit the "on" button, Nolan says. It the programs do not receive the applications, "I'm not sure what the contingency strategy is," he warns (Cheney, Politico, 10/24).

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