State says it’s hard at work on Medicaid backlog

A state health agency says it’s working though the application backlog for Medicaid that recently provoked federal scrutiny.


The Department of Community Health has made decisions on eligibility for up to 70 percent of the 88,854 “account transfers” from Georgia’s insurance exchange, the agency said Friday.

The backlog in Georgia is 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, as is happening in some states, because Georgia has declined to pursue expansion. But Georgia is reported to have 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.

“We have been in the process of comparing the information in the account transfers to our various eligibility databases for several weeks,’’ said Pam Keene, Community Health spokeswoman, in an email to GHN. “Those who were found eligible are already receiving benefits. Those who were deemed ineligible have been notified and referred to the [exchange] where appropriate.”

An estimated 18,000 of the transfer files processed have been enrolled in Medicaid or PeachCare, Community Health said. But because the account transfers represent families with possibly more than one person eligible, the number enrolled would be higher.

Only about 30 percent, or roughly 26,000 of the 88,854 transfer files, Keene said, “will require additional follow-up, which will begin soon.”

Keene said the remaining cases must be manually and individually reviewed to determine all necessary information is included so that they can be processed.

The federal Centers for Medicare and Medicaid Services said earlier this month that it would review eligibility and enrollment processes for Medicaid and the Children’s Health Insurance Program (CHIP) in Georgia and six other states. It cited as a reason “a substantial backlog of pending applications.”

CHIP in Georgia is known as PeachCare.

The notification from CMS came in a July 9 letter. The other states getting this backlog letter were Arkansas, Illinois, Indiana, North Carolina, Virginia and Wyoming.

Besides these seven states, CMS had previously notified another six states to submit plans to fix their Medicaid enrollment snags. That group included Tennessee, where on Wednesday three consumer advocacy groups filed a lawsuit accusing state officials of adopting policies that deprive thousands of people of Medicaid coverage “to score political points.”

Tennessee officials did not immediately comment on the lawsuit.

Jane Perkins, legal director of the Washington-based National Health Law Program, one of the groups that filed the suit in U.S. District Court in Nashville, told Kaiser Health News that Tennessee is the first state to be sued over the Medicaid enrollment problems. The other plaintiffs, the Kaiser report said, are the Southern Poverty Law Center in Montgomery, and the Tennessee Justice Center, based in Nashville.

The lawsuit alleges that Tennessee makes it harder than any other state to enroll in its Medicaid program, called TennCare.

Under federal law, an application for Medicaid benefits must be processed within 45 days. But people in Tennessee are waiting as long as six months, the suit said.

Here in Georgia, 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 tentatively 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.

A total of about 1.9 million Georgians are enrolled in Medicaid and PeachCare.

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 in limbo for as long as eight months.

The reasons for the problems include technological glitches that prevented the federally run exchanges from transferring data on applicants to state Medicaid agencies. (Most states have federally run exchanges.) Also, many states were unable to handle an enrollment surge because of inadequate staffing, their own computer problems and other issues, KHN reported.