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CMS offers HealthCare.gov workaround to enroll Medicaid applicants


By Virgil Dickson
Posted: December 2, 2013 - 3:00 pm ET
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The federal HealthCare.gov enrollment portal still isn't able to transmit completed applications to state Medicaid agencies, so the CMS is suggesting a workaround to make sure Medicaid-eligible applicants to the site get coverage that begins Jan. 1.

The 36 states that are not operating health insurance exchanges are relying on the federal marketplace to either assess or determine Medicaid eligibility for applicants who apply for coverage at HealthCare.gov. The site is supposed to transmit applications for eligible applicants to state agencies but has not been able to perform this function since open enrollment began Oct. 1.

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The Obama administration officials declared this weekend that the site “runs smoothly” for the vast majority of users. Much work, however, remains ahead of the CMS and its contractors to repair and build back-end portions of the site necessary to coordinate applications with insurers and state agencies.

As a stopgap measure for the Medicaid issue, the CMS has been sending weekly data transmissions to state Medicaid officials with limited information about individuals who have been tentatively deemed eligible for the program. These transmissions, known as “flat files,” were never meant to be used to enroll anyone, according to the CMS. Rather, they were meant to prepare agencies for the work of sorting through new enrollees.

However, in a letter sent to state officials late Friday (PDF), the federal agency reversed course and is now asking states to use the files to enroll people in the program.

A CMS spokesperson said the strategy is a means of “providing states with additional flexibility to use existing processes to enroll individuals in Medicaid and CHIP who applied through the federal marketplace.”

Using the CMS' proposed workaround will require state agencies to come up with a process for converting the files to a data format they can use in making eligibility determinations, said Michelle Glady, press secretary for the Florida Department of Children & Families.

Some state officials, meanwhile, say that the information they're getting from Washington is insufficient to make eligibility determinations and is often riddled with errors. For example, they say, some of the people identified as eligible for new coverage are already enrolled, and others don't live in the state.

Also, some states have complained that the CMS has not scrubbed the files of applicants who don't qualify for coverage because their state chose not to expand Medicaid eligibility under the reform law. In South Dakota, for instance, the majority of the individuals identified by the CMS so far as potential Medicaid enrollees “will not be found eligible,” said Kristin Kellar, communications director at the South Dakota Department of Social Services.

Before the CMS' letter last week, states had been telling residents left in limbo by HealthCare.gov to apply directly to their Medicaid programs. In Wyoming, “very few” of the residents tentatively deemed qualified by HealthCare.gov have contacted the Wyoming Department of Health, according to Jan Stall, the department's eligibility and operations administrator.

In response to these concerns, the CMS has indicated that it will enhance the files with additional information, such as dates of birth and Social Security numbers. Officials say they hope to be able to send complete Medicaid transmissions “as soon as possible,” but they remain unable to say when.

Follow Virgil Dickson on Twitter: @MHvdickson


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