States have made major strides in automating their processes used to determine eligibility for Medicaid and the Children's Health Insurance Program. But challenges remain in verifying user data and re-enrolling certain populations, said federal and state officials during a webinar Tuesday.
As of Jan. 1, 49 states and the District of Columbia have an online application for Medicaid, CHIP, or both, up from 37 in January 2013. The sole holdout is Tennessee which has no electronic application of its own and relies on HealthCare.gov to determine eligibility, according to the Kaiser Family Foundation's 13th annual survey on eligibility, enrollment, renewal and cost-sharing policies in Medicaid and CHIP.
In addition, 47 states now provide the option of telephone applications compared with 15 in January 2013.
The findings are good news as “the goal of the Affordable Care Act was to move away from a paper-driven process,” Tricia Brooks, co-author of the report and a researcher at Georgetown University's Center for Children and Families, said Tuesday during a Kaiser webinar on the annual survey.
While states are pleased they've been able to finally digitize their Medicaid applications, they are facing challenges that still mean many applications must be manually processed.
“We have struggled authenticating individuals,” Rex Plouck, portfolio manager for Ohio Gov. John Kasich's Office of Health Transformation, said during the webinar.
If someone with a common name like Bob Smith applies for coverage, for example, it can be a challenge to make sure they are looking at the correct person when assessing eligibility. So such individuals tend to be pulled out for manual processing, he said.
Consumers also are submitting inaccurate information. “Much of the data that's being submitted doesn't match IRS data, so then there's a manual process for these individuals to verify income,” Plouck said.
These ongoing tech issues make it likely that states will continue to rely on a pool of funds to help them with IT-related costs for Medicaid, Kaiser says. In 2011, the CMS raised the matching rate to 90% from 50% for money that states spend on building eligibility and enrollment systems and to 75% from 50% for maintenance and operations of those systems. The bump in funds was set to expire in December 2015 but CMS announced late last year it was making the federal match rates permanent.
Another issue plaguing several states is that they are facing a major challenge re-enrolling children and blind or disabled individuals who were enrolled in Medicaid prior to the effective date of two Patient Protection and Affordable Care Act provisions.
The provisions are the 2014 expansion of coverage to all adults with incomes up to 138% of the federal poverty level, and the establishment of a new formula to define household income under the Modified Adjusted Gross Income (MAGI) standard, Vikki Wachino, deputy director of the Center for Medicaid and CHIP Services at the CMS, said during the call.
Some people have been losing coverage as a result of the challenges in renewing this population. The agency is optimistic all states will get a handle on this issue by the end of the year, officials said.
Follow Virgil Dickson on Twitter: @MHvdickson