However, states remain split on whether to use the workarounds or wait until fully automated transfers can take place, which means thousands of applicants will remain in limbo waiting for coverage that was supposed to begin Jan. 1.
The 36 states that are not operating their own insurance exchanges are relying on the federal marketplace to screen for Medicaid eligibility when applicants seek coverage through HealthCare.gov.
To date, no state is getting full Medicaid applications that they can use to actually enroll potential beneficiaries. Some are getting completed applications, but they are meant only to test transmissions between their systems and HealthCare.Gov. States getting these files are analyzing them for quality and accuracy.
Others are getting weekly data transmissions with limited information about individuals who have been tentatively deemed eligible for Medicaid. 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. Some states have complained that these files are riddled with errors.
In December, the CMS committed to improving the quality of the flat files and said it would grant waivers that allow states to use the files for Medicaid enrollment. Few took them up on the offer. To further entice states, the CMS held a call and sent out a letter Jan. 3 in which it highlighted additional enhancements to the flat files that states with added data fields for income and gender.
One state that has gotten a waiver is Arkansas, where the process has not been as smooth as promised by the CMS, according to Amy Webb, communications director for the Arkansas Department of Human Services.
Arkansas differs from most states that are expanding their Medicaid programs in that it's using funds from the federal government to enroll those earning between 100% and 138% of the federal poverty level into private plans sold on the insurance exchange instead of adding those individuals to the state's Medicaid rolls.
The files have not specified the counties where applicants live, for example, which the state needs in order to identify plans for them.
As a result, they've had to manually figure it out.
The CMS is also offering to call those tentatively deemed eligible to apply directly through their state's website instead of waiting for their application to be transmitted from HealthCare.gov. However, states must ask the federal agency to make the calls.
For some, the option doesn't go far enough. Jennie Melendez, a spokeswoman for the Oklahoma Health Care Authority, said the CMS declined a request to add a message to the federal website that directs applicants to state sites. “This was the compromise,” Melendez said.
Pennsylvania, another state that’s directing potential beneficiaries to apply through its own website, is assuring residents that glitches with the federal website won’t prevent anyone from getting enrolled as long as they tried to sign up on time.
“We’re trying to get people into the system as quickly as possible and if you signed up by Dec. 24, your coverage will be retroactive to Jan. 1,” said Eric Kiehl, director of communications at the state’s Department of Public Welfare.