Much work remains on Medicaid upgrades, survey finds

States have made progress in implementing Medicaid upgrades required by the 2010 federal healthcare overhaul but much work remains to be done, according to an annual survey of all 50 programs.

Only about 20 states have indicated that they expect to expand their Medicaid programs' eligibility to all residents with incomes of up to 138% of the federal poverty level, as authorized by the Patient Protection and Affordable Care Act, said Diane Rowland, executive director of the Kaiser Commission on Medicaid and the Uninsured. The Supreme Court's 2012 decision upholding the law eliminated financial penalties for states that do not undertake the expansion.

All states are required to implement upgrades to their systems by next year, but relatively few have completed these, according to her group's 12th annual survey of the states.

“2014 will also usher in some very important changes in states with the coverage expansion and without; it will change many of the requirements for how state enrollment works and how that experience will be for families,” Rowland said.

One of the 2014 upgrades that states are required to implement involves improving their eligibility systems to offer automatic electronic renewals instead of in-person, paper-based application systems. Only 22 states have implemented such automatic renewals, according to the survey.

Similarly few states have upgraded decades-old enrollment and renewal methods beyond in-person or mail-based systems. Only 16 states offer both online and telephone enrollment, and 19 states offer renewal through those means, according to the survey.

Cindy Mann, director of the Center for Medicaid and CHIP at the CMS, acknowledged that states have had challenges implementing the law's required upgrades but emphasized their progress.

“We understand that it is a lift,” she said about the required Medicaid upgrades.

Many states have not converted their Medicaid programs' income eligibility standards, or asset tests, to a common federal standard for parents but have done so for child applicants, according to the survey.

“Some states have not dropped asset tests for parents but they have for children, so they know how to do that,” she said.

Overall, Mann was optimistic that all states would meet the federal law's 2014 requirements. “So we're all pulling together and I think we'll make it,” she said.

Mann's optimism about preparing for the 2014 upgrades was echoed by one Medicaid official from a state that has undertaken many of the required application upgrades, despite no expectation that it will expand enrollment next year.

“It can be done; it can be Web-based, it can be paperless and it can be real time—even though for some states it can seem daunting at times,” Nico Gomez, deputy CEO of the Oklahoma Health Care Authority, said about his state's enrollment and eligibility determination upgrades.

Among the survey's cautionary notes is that even with a national effort to bolster Medicaid programs and to expand their enrollments, many states experienced contractions and spending cuts in their programs in 2012. For instance, Colorado undertook a limited Medicaid expansion in 2012 that added coverage of adults, but Hawaii, Illinois and Minnesota reduced adult Medicaid eligibility to cut costs.