Dive Brief:
- California isn’t the only state lagging in its processing of Medicaid applications. CMS has given California and five other states—Alaska, Kansas, Michigan, Missouri and Tennessee—until July 14 to submit correction plans on how they intend to fix Medicaid enrollment backlogs.
- In June 27 letters, CMS demanded that the states provide updated mitigation plans to address gaps existing in their eligibility and enrollment systems. CMS gave states 10 days to respond.
- California runs its own exchange; the other five states use federally facilitated exchanges. Of the six states, only California and Michigan opted to expand Medicaid under the Affordable Care Act.
Dive Insight:
Nationwide, about 6 million people have gained Medicaid coverage since September, mostly from the ACA's Medicaid expansion. In June, Kaiser Health News analyzed 15 large states and found 1.7 million-plus people waiting, some as long as eight months, for Medicaid applications to be processed.
Why? Partly from up-front technological glitches that prevented the federal exchange from transferring data on applicants to state Medicaid agencies. From the states' end, many states couldn't handle enrollment surges due to inadequate staffing or their own computer problems, among other issues.
Public responses from the targeted states varied. A Tennessee Medicaid spokeswoman denied the state has a backlog of applications, telling Kaiser Health News there were "numerous aspects of the [CMS] letter with which we do not agree." She said Tennessee was working on its response.
California cited progress, noting that its backlog has fallen from about 900,000 pending Medicaid applications in May to about 600,000 cases now; typically, states have 45 days to process enrollment.
Missouri has 20,000 pending Medicaid applications, a state official said. She downplayed the situation, telling the St. Louis Post-Dispatch that the state gets Medicaid applications on a daily basis, so "we will always have pending applications." But the paper said Missouri residents described waiting months for applications to be processed, and making hours-long phone calls to "support" hot-lines.
The real issue is what the six states will tell CMS, and how federal regulators will respond to them.