More than 50,000 uninsured Georgians – many of them children – have been assessed as eligible for Medicaid or PeachCare coverage through the enrollment process for the health insurance exchange, according to a report this week.
But because of technological snags, few if any of these Georgians appear to be joining these government insurance programs. A spokeswoman for the state Department of Community Health said the agency is working on the issue, but did not elaborate.
Georgia is one of 36 states using the federal insurance exchange. But unlike roughly half of those states, Georgia is not able to process applicants into Medicaid and their children’s insurance program.
In addition, the Peach State does not appear to be pursuing the option to process “flat file’’ applications of people deemed eligible, which five other states are doing.
Proponents of the Affordable Care Act, the federal law that set up the insurance exchange, are critical of what they see as Georgia’s inaction on this enrollment.
The ACA’s creators expected the exchange would not only help people buy coverage, but also have a major side benefit: It would help identify and enroll people already eligible for Medicaid and the Children’s Health Insurance Program (known as PeachCare in Georgia).
But the difficulties in enrolling that group into those government programs have mirrored the technological problems that plagued the healthcare.gov website after its Oct. 1 debut.
Even for the 18 states that are getting data more smoothly, it isn’t an easy process. All those states are having to do much of the process manually, said Andrea Maresca, director of federal policy and strategy for the National Association of Medicaid Directors.
There are errors and problems in the files sent from the federal exchange to the states, especially in the applications that were sent in October and November, Maresca said.
“States are still having to look for those defects in the data,’’ she said.
The ‘flat file’ issue
Federal officials, meanwhile, are providing every state with so-called “flat files’’ on eligible people. These files are similar to Excel spreadsheets, and provide basic information on eligible individuals. States, though, often have to follow up to fill in missing or incomplete information.
CMS has approved waivers for five states to use the flat files to enroll eligible people. CMS says other states are using the data for consumer outreach, according to Inside Health Policy.
“We strongly encourage all [federal exchange] states to consider enrolling eligible individuals based on the information now being shared with states,’’ said Cindy Mann, director of the federal Center for Medicaid and CHIP Services (CMS) in a recent information letter. “This will expedite enrollment for individuals and help states address workload issues.”
But Georgia’s Department of Community Health, in a January email to WABE, said the state’s information systems are not designed to accept a flat file. The work-around, spokeswoman Pam Keene wrote, is administratively inefficient and increases the risk of duplication, WABE reported.
Someone could receive benefits now, only to see them revoked later, Keene said.
Accepting a flat file without state processing and validation would mean Georgia is ceding the authority to determine eligibility to the federal government, Keene said in the email. Georgia has taken the position that the state, not the federal exchange, “should evaluate and determine eligibility” for Medicaid.
Cindy Zeldin of the consumer group Georgians for a Healthy Future is critical of what she sees as the state’s go-slow approach. She noted that there are more than 200,000 uninsured children in Georgia, and most of them are eligible for Medicaid or PeachCare.
“This represents a golden opportunity to dramatically improve our state’s coverage rate for children and to accomplish that long-sought-after goal of finding and enrolling eligible kids into coverage,” she said. “We encourage the U.S. Department of Health and Human Services and the state’s Department of Community Health to work together to get these kids and their parents enrolled.”
States that are running their own exchanges, meanwhile, are also experiencing problems in enrolling those deemed eligible for government coverage.
“It’s a mixed bag,” Maresca says. “In some states, the exchange and the state Medicaid agency systems are talking. For some, it’s a manual process. It’s not a seamless process.”
This enrollment is a priority for Medicaid directors and for CMS, Maresca said.
“People are spending a lot of time to make this right.”