Thousands of poor Georgians are trapped in governmental purgatory with no clue when — or whether — they may finally get health coverage. The culprit: a chronic disconnect between federal and state systems that is still festering nearly six months into the Health Insurance Marketplace’s operation.
About 90,000 people who applied for coverage on HealthCare.gov are potentially eligible for Georgia’s Medicaid program, the federal government has concluded. But, state officials say, the feds haven’t given them enough information about these individuals to verify that they actually qualify for Medicaid. Equally troubling, they say, is that the data they have is unreliable.
“There are a lot of inconsistencies,” Department of Community Health Commissioner Clyde Reese said. “Some of (the applicants) were actually from other states, so we’ve been hesitant to use that to make any true eligibility determination.”
When the marketplace launched last October it was supposed to be a one-stop shop — seamlessly directing millions of Americans to the kind of health coverage that was appropriate for them, whether Medicaid or a private insurance plan.
But the federal and state computers were unable to talk to each other, a problem that still persists in many states today.
The lingering problems have proved irksome — even for some Georgians who aren’t trying to enroll in Medicaid.
When HealthCare.gov deemed his son eligible for PeachCare for Kids (the Medicaid program for children in Georgia), Matt Cramer of Covington was skeptical — for good reason.
Cramer, who works for a small company specializing in race car electronics, makes too much money for his child to be on PeachCare. But until Cramer could get a rejection letter from the state, a marketplace representative told him, he couldn’t access federal tax credits available to help him buy private insurance through the site.
He was told to fill out a new application on HealthCare.gov. Then he was told to go directly to the state’s Medicaid application website, COMPASS, with no immediate results. He called the state numerous times, including spending an hour and 20 minutes on hold during one call, but couldn’t get a live person on the phone. Cramer’s pregnant wife trudged down to the state’s Division of Family and Children Services office in person — the first of four such visits — in search of answers.
“We just tried to keep plugging away,” Cramer said. “It was like climbing the Matterhorn of red tape.”
Data delivered but not verified
Federal officials were supposed to send states verified information about applicants, such as names, income and social security numbers, but that verification hasn’t happened.
“(The federal government) has been working closely with states to ensure that applications for Medicaid coverage are processed,” said Emma Sandoe, a spokeswoman for the Centers for Medicare & Medicaid Services. “Many states are able to enroll individuals based on the information provided to states by the federal marketplace and by other flexibilities.”
But not Georgia.
A growing number of states are now able to receive all of an applicant’s information from HealthCare.gov. But even those that have are still having trouble processing the files and are having to resort to manual data entry.
Georgia health officials said they too would have to enter data manually to be able to use it.
The feds say they are continuing to work with Georgia and other states where there are still problems and telling people who applied on HealthCare.gov to reach out to their state Medicaid agencies directly. Medicaid provides health coverage to 1.7 million low-income children, pregnant women, the elderly and the disabled.
Reese, whose Department of Community Health administers Medicaid in Georgia, said the state’s system is ready to receive the federal data and he plans to wait until he gets the full files to begin enrolling people who qualified through the marketplace. It’s unclear when that will happen.
He added that approving people for Medicaid without all of the necessary information would risk having to rip health coverage away from families if it’s found later that they don’t qualify after all.
182,000 kids qualify but aren’t covered
Consumer advocates say the ongoing technical troubles are a barrier for low-income families trying to get health coverage at a time when millions of Americans are gaining it because of the Affordable Care Act.
This is an opportunity to help people get access to the care that they need, but they’re getting lost between the state and the feds, said Cindy Zeldin, executive director of the nonprofit Georgians for a Healthy Future.
Many of those falling through the cracks are probably children, Zeldin said. About 182,000 children in Georgia are eligible for Medicaid but remain uninsured — the fourth-highest rate among states behind Texas, California and Florida, according to a study by the Urban Institute.
“There just needs to be a way that the state works proactively with HHS to figure this out and get it done,” Zeldin said. “Other states are developing strategies to take these files and follow up with people and get them enrolled.”
Technical issues notwithstanding, states have made a lot of progress, said Robin Rudowitz, a Medicaid expert with the nonprofit Kaiser Family Foundation. The federal government has given states, some of which still used paper records, hundreds of millions of dollars to upgrade IT systems to make Medicaid enrollment easier and quicker for applicants.
“I can’t stress enough how antiquated many of them were,” Rudowitz said.
She added that while open enrollment for private insurance plans on the marketplace ends March 31, people who qualify for Medicaid can enroll any time during the year.
‘Take out Washington with a woodpecker’
As for the Cramer family, more than 40 days after their original application, the couple finally managed to get a PeachCare rejection letter.
Then it took several more phone calls to the federal marketplace before they managed to get a hold of someone who knew what to do with it.
Finally, after 52 days, success. Cramer and his wife qualified for a tax credit and purchased an insurance plan for about $300 a month.
Cramer said he’s happy to have the insurance but believes people need to be held accountable for the marketplace’s problems.
“If government buildings were built like the government health exchange, you could take out Washington D.C. with a woodpecker,” he said. “It was really badly implemented.”
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