In December, the CMS created a work-around option, because the HealthCare.gov website was not functioning properly. Instead of automatically transferring applications to the states, it sent weekly text files with individuals' names, social security numbers and other information to allow the states to determine eligibility and enroll their qualifying residents.
On June 27, the federal agency sent the states letters asking them if they planned to continue to use the temporary fix, or if they were any closer to creating a more seamless process. The agency's concern is the wait time involved while the states manually determine eligibility from the text files sent by the CMS.
Relying on the files hasn't created a larger backlog than usual in Missouri, which did not expand Medicaid, according to Rebecca Woelfel, spokeswoman for the Missouri Department of Social Services.
“Medicaid applications are received on a daily basis, therefore, we will always have pending applications,” she said. “The number of applications pending has returned to a normal volume which is typically around 20,000.”
Missouri plans to respond to the CMS by Monday to address how it plans to obtain applications from HealthCare.gov, but Woelfel declined to say what that response would entail.
In Michigan, officials say they are still working with the CMS on technical issues, but claim that hasn't slowed access to getting into Healthy Michigan, the state program set up for adults making up to 138% of the federal poverty level. The offering launched April 1, and now covers more than 323,000 residents, already surpassing the state's 2014 goal of enrolling 322,000 individuals, according to Angela Minicuci, a spokeswoman for the Michigan Department of Community Health.
Officials in Kansas, a non-expansion state, are also hoping to soon have a more seamless electronic-enrollment process, but like Michigan, they say relying on the files from CMS has not unduly slowed Medicaid enrollment.
“There is currently no backlog processing Medicaid eligibility applications,” said Sara Belfry, a spokeswoman for Kansas Department of Health and Environment.
There were 426,642 Kansans in Medicaid as of April 2014, up 7.6% from 396,374 enrollees during the same time period last year, according to state records.
Unlike the other states, Tennessee is able to receive and send data to HealthCare.gov, but the CMS is still concerned about other issues plaguing the state that may be slowing Medicaid access. For example, the federal agency has created a more accurate way to determine income that both expansion and non-expansion states must adopt, but Tennessee has yet to do so, according to the federal agency.
“There are numerous aspects of the letter with which we do not agree, and we are currently working on our response to CMS,” said Kelly Gunderson, a spokeswoman for TennCare, the state's Medicaid program.
Tennessee is currently enrolling individuals at the highest rate since TennCare began more than 20 years ago and has no backlog of potential enrollees, she said.
California (PDF), which expanded Medicaid and has its own exchange, also received CMS correspondence because technical problems there have prohibited the state from enrolling a large number of eligible individuals, the CMS said. The number of pending enrollees seeking Medi-Cal coverage, the state's Medicaid program, is now at 600,000, according to Carol Sloan, a spokeswoman for the California Department of Health Care Services.
Despite the wait list, others have been able to make it on the program's rolls. Enrollment in Medi-Cal has grown by more than 800,000 people since the end of March.
While the state continues to iron out kinks in its system, which includes an inability to obtain information from applicants to verify their eligibility, there will likely always be some people waiting to get coverage, Sloan said.
“For a program of Medi-Cal's size, there have always been pending individuals awaiting enrollment and, as has always been the case, it is our responsibility to work with the counties and other partners to process applications and enroll individuals into coverage,” she said.
Alaska officials could not be reached for comment by deadline. The CMS did not return a request for comment beyond the letters it sent.
Follow Virgil Dickson on Twitter: @MHvdickson