April 26, 2015

Officials hope to eliminate Medicaid backlog by end of month

State officials say a Medicaid application backlog should be cleared up by the end of next week.

Officials with the South Carolina Department of Health and Human Services say they were overwhelmed by more than 38,000 applications received through the online Healthcare.Gov insurance exchange enrollment back in April. These enrollees were people who believed they were eligible for Medicaid when they enrolled on the exchanges under the Affordable Care Act.

The work was first reported by the Associated Press on Monday.

Deputy Director of Eligibility, Enrollment, & Member Service Beth Hutto said the backlog should be manageable by August 22. However, she added that federal officials have not yet transferred up to 6,000 applications.

She said the agency was not prepared to receive more than 38,000 applications in a two-month period from February to April. “We had thought we’d be getting them transferred over to us in real-time (when enrollment began in November) and they would just be part of our normal workflow,” she said. “It didn’t happen that way. It was more of a large… batch that came over to us at one time.”

The agency usually receives around 1,000 applications per week, she said. The agency has hired six temporary staffers to help relieve the workload of employees who review applications, Deputy Director of Information Management John Supra told the Associated Press.

Visitors to the Healthcare.Gov website could use the site to enroll in private, subsidized insurance as part of the health care reform law. If those visitors likely qualified for Medicaid, the site was supposed to send their data to the Medicaid agency in their state. But federal Medicaid executives said problems with the site were causing delays.

Hutto said DHHS has been able to process about 62 percent of the applications so far. But she added an exceptionally large number of those (40%) were applications for disability or long-term care, which require more in-depth reviews. She anticipated staff would be able to more easily navigate through the remaining applications for the more usual coverage of families and children.

Of those processed applications, only 56 percent have been approved. Hutto said that’s a much lower acceptance rate than the roughly 70 percent average submitted by counties around South Carolina each week. She believes part of that was due to Healthcare.Gov users who incorrectly thought they were eligible.

Hutto emphasized that families and other residents can still enroll in Medicaid at any time and do not have to wait to use Healthcare.Gov when open enrollment begins again in November.