The 38 states that rely on the federally facilitated marketplace to determine eligibility and facilitate enrollment must electronically transfer accounts between Medicaid and HealthCare.gov. The majority of these states can receive and send transfers of information. But 20 states say the transfers are delayed or problematic. The survey didn't specify the issues are or their severity.
“We have more work to do at the federal level on strengthening our coordination with states and I think we're making progress,” CMS Medicaid Director Vikki Wachino said during a briefing about the report Thursday.
The states in question are Alabama, Alaska, Arizona, Arkansas, Florida, Illinois, Iowa, Kansas, Maine, Missouri, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oregon, Pennsylvania, South Carolina, West Virginia, and Wisconsin.
Although challenges remain, the report notes there has been tremendous progress from when HealthCare.gov first launched in 2013. At that point, and for months after, the site was not able to transfer applications for eligible Medicaid applicants to state agencies.
The Kaiser survey also revealed various steps taken by the states to enroll more eligible low-income people in Medicaid, keep eligible individuals enrolled, reduce paperwork burden and improve administrative efficiency.
All but one state, Tennessee, has begun taking applications for Medicaid by telephone, up from 15 in 2013, and all but Tennessee now takes online applications, up from 37 in 2013. Previously, many states had required applicants to complete paper applications or apply in person, leading to delays, according to Kaiser.
Another sign of progress is that 34 states can now process automated renewals using information from electronic data sources versus none in 2013.
“Research has shown that as many as 30% of people lose coverage at renewal time even though they remain eligible,” Tricia Brooks, senior fellow at Georgetown University Center for Children and Families, said during the briefing Thursday. “That's largely because of paperwork challenges, but we are seeing significant progress on streamlining the renewal process.”