Feds to scrutinize Georgia’s Medicaid backlog

A federal agency says it will review Medicaid eligibility and enrollment processes in Georgia and six other states due to “a substantial backlog of pending applications.”

The July 9 letter from the Centers for Medicare and Medicaid Services does not indicate how much of a backlog Georgia has or the reasons for it.


The Georgia review will also cover the state’s PeachCare program for uninsured children.

The other states getting this backlog letter were Arkansas, Illinois, Indiana, North Carolina, Virginia and Wyoming, according to Inside Health Policy.

(Besides these seven states, CMS had previously notified another six states to submit plans to fix their Medicaid enrollment snags.)

The backlog in Georgia appears linked to the thousands of people expected to join Medicaid and PeachCare this year as a result of the Affordable Care Act.

These new enrollees are not coming in because of expansion of Medicaid, which is called for under the ACA and would have made more people eligible. Georgia has opted against expansion, citing the cost. (The U.S. Supreme Court has ruled that states cannot be compelled to do it.)

Yet an enrollment surge is still anticipated. That’s because Georgia has tens of thousands of people who are already eligible for Medicaid or PeachCare but have not been getting it. Their names have emerged through the enrollment process in the ACA’s insurance exchange, and under the health law’s design, they would be referred to the two government health programs.

Officials with the Georgia Department of Community Health, which runs Medicaid and PeachCare in the state, said Monday evening in an email to GHN that the agency received files of 88,584 “account transfers” from the federally run insurance exchange in May and has been processing those that are deemed complete to determine eligibility.

“We are individually processing these files as quickly as possible and comparing applicants through the [insurance exchange] with people who have also applied for Medicaid directly through the state,” said the email.

Community Health officials told GHN in May that the state was finally getting a seamless electronic transfer of data on applicants from the health exchange. These potential sign-ups in Georgia had been stalled for months due to technological snags.

Federal health officials reported that more than 91,000 Georgians were identified through the health insurance exchange as eligible for Medicaid or PeachCare.

Georgia has estimated that this “woodwork effect” (people coming out of the woodwork) would lead to 120,000 people joining the two programs – more than 90,000 of them children.

As of this month, a total of about 1.9 million Georgians are enrolled in Medicaid and PeachCare.

The July CMS letter to Jerry Dubberly, the state’s Medicaid chief, said the main goal of the federal review “will be to gather additional information to determine the reasons for the backlog of applications, at a level of detail that would allow CMS to discern what numbers of people are being impacted, for what length of time, and by what operational or technical challenges or gaps.”

Tim Sweeney
Tim Sweeney

Tim Sweeney, health policy director at the Georgia Budget and Policy Institute, said Monday that he was aware that the state was still having difficulty processing applications from the exchange.

The backlog, he said, may indicate that the state does not have “enough resources and emphasis’’ on this enrollment. Most of those in the applicant backlog are children, Sweeney noted.

Georgia has the fourth-highest number of uninsured children in the nation, he said. A report last year said Georgia trailed only Texas, California and Florida — all states with much higher overall populations than Georgia.

Sweeney compared the Medicaid situation to the food stamp backlog that Georgia recently faced. These backlogs, he said, may show “there’s not significant capacity to deal with the demand for services.”

In June, CMS had contacted six other states and given them a deadline to submit plans to resolve issues that have prevented more than 1 million low-income or disabled people from getting Medicaid coverage.

Those targeted states were Alaska, California, Kansas, Michigan, Missouri and Tennessee.

A Kaiser Health News analysis of 15 large states in June found that more than 1.7 million more were still waiting for their applications to be processed — with some stuck in limbo for as long as eight months.

The reasons for the problems include technological glitches that prevented the federal exchange from transferring data on applicants to state Medicaid agencies. Also, many states were unable to handle an enrollment surge because of inadequate staffing, their own computer problems and other issues, Kaiser Health News reported.