Oct. 16—Some states are reporting increases in Medicaid enrollments, despite technological failings in the federal and state websites established to enroll applicants in insurance.

Some states have reported a surge in Medicaid enrollments as part of the Affordable Care Act’s (ACA’s) push to expand insurance coverage. Those increases have come despite widespread technological problems in the federally and some state-operated websites that were intended as the primary tool to enroll 16 million in coverage next year.

For instance, Arkansas’ Medicaid program received 2,628 applications through its website, phone calls, or in-person applications, while 53,660 residents were found eligible by the state and confirmed their interest through a state letter writing campaign, according to Amy Webb, a spokeswoman for the program. The enrollment process was completed by 10,454 applicants, and nonrespondents will be auto-enrolled.

Arkansas officials did not know how many applicants were found eligible for its expanded Medicaid program by the federal health.gov enrollment site. The website for the 36 federally run state marketplaces will not report enrollments publicly until November, a Centers for Medicare & Medicaid Services (CMS) official said.  

Taking a Closer Look

The expansion of Medicaid eligibility to all residents with household incomes of up to 138 percent of the federal poverty level was expected to add 9 million beneficiaries to Medicaid in 2014, according to the nonpartisan Congressional Budget Office. That increase was expected despite the refusal of 26 states to expand their Medicaid programs.

The Arkansas enrollment effort moved the state far toward that state’s estimate that expansion would add 220,000 newly eligible residents to the program. The state’s Medicaid expansion used private insurance sold in the new marketplace to cover much of the newly eligible population.

The early success in Arkansas was “very encouraging” to the state’s hospitals, which pushed the expansion through a tough legislative battle, said Bo Ryall, president and CEO of the Arkansas Hospital Association. Hospital officials hope the ACA’s expanded coverage of previously uninsured patients will help offset some of the $379 billion in Medicare hospital cuts the law includes from 2012-2021.

“Having this many newly insured people with certainly not make up for those Medicare reduction, but it will help make up for a shortfall that is very large,” Ryall said in an interview.

Arkansas’ successful effort stemmed from its search of its other public assistance programs for applicants whose incomes would qualify them for the expanded Medicaid program. Other states that have had similar successes in enrolling newly eligible Medicaid beneficiaries (by culling their Supplemental Nutrition Assistance Program, for instance) include West Virginia and Illinois, said Andrea Maresca, director of federal policy and strategy for the National Association of Medicaid Directors.

“I don’t think we’ve seen the challenges (experienced by healthcare.gov) in the states’ eligibility systems because this isn’t entirely new to the states,” Maresca said in an interview.

Medicaid officials in Illinois and West Virginia did not respond to requests for their latest enrollment figures.

Positive state Medicaid enrollment efforts include some web-based enrollments. For instance, Washington state reported that 21,865 people, or 88 percent of the 24,949 applicants who completed enrollments on its insurance website from Oct. 1 to Oct. 14, were added to the state’s Medicaid program. Such Medicaid enrollments compared with estimates of as few as 5,000 enrollees in the 36 federally run websites.

Todd Nelson, director of healthcare finance policy, operational initiatives for HFMA, credited the apparently more successful effort by states to enroll applicants in their Medicaid programs to the longstanding experience of states with the process.

“They’ve got a process and they’re used to it,” Nelson said about state enrollment efforts. “It appears the states have it figured out a little better at this point.” 

Challenges Remain

Further Medicaid enrollment could be limited by ongoing technical failings of the federal and state-run websites and other problems, according to healthcare policy experts.

For instance, an unknown number of Arkansas hospitals have yet to receive approval for their applications to serve as certified application counselors (CACs), according to Ryall. Hospitals have been encouraged by federal officials and hospital representatives to train staff through the CAC program, which would allows them to provide detailed enrollment assistance to applicants to either marketplace insurance plans or Medicaid programs. Ryall blamed the ongoing federal shutdown for the application delays.

Ryall expects hospital efforts to drive enrollments to accelerate in November as the Dec. 15 enrollment deadline for coverage to begin Jan. 1 nears and as hospitals’ CAC enrollments are approved.

Another potential complication stems from CMS’s one-month delay in sending Medicaid eligibility determinations of applicants to the central federal enrollment site to the states. 

“It’s not ideal,” Maresca said about the decision to send all Medicaid enrollee information to the states on Nov. 1, after technical problems are resolved.

Such a large amount of data delivered at one time could complicate state efforts to enroll those applicants. States began reporting Oct. 16 that CMS officials have tried to mitigate the problem of a large “data dump” by starting to send small amounts of Medicaid data.  

Rich Daly is a senior writer/editor in HFMA’s Washington, D.C., office. Follow Rich on Twitter: @rdalyhealthcare.


Publication Date: Wednesday, October 16, 2013