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.