With open enrolment over for private health insurance claims, states are struggling to process hundreds of thousands of Medicaid applications
Last week, federal health officials celebrated two milestones related to the Affordable Care Act. The first, which got considerable attention, was that more than 7 million people selected private health plans in state and federal health insurance exchanges. The second, which got less attention, was that some 3 million additional enrollees had signed up for Medicaid and the Children's Health Insurance Program (public health insurance programs for the poor), many as a result of Medicaid's expansion.
But there are growing signs that Obamacare's Medicaid expansion is a victim of its own success, unable to keep up with demand. While about half the states have refused to expand their Medicaid programs' eligibility, among those that have, some can't process applications fast enough.
Media reports from New Jersey, Illinois and California (states that have expanded their Medicaid programs) show that hundreds of thousands of consumers who may qualify for new Medicaid coverage aren't getting it.
So what's happening?
In Illinois, the Chicago Tribune reported last month that there's a backlog of more than 200,000 applications waiting to be processed.
Illinois officials initially expected 200,000 people to sign up for Medicaid under the expansion in 2014. But through last week, more than double that number have applied. And amid a marketing blitz, officials expect a surge of additional applications by the end of the year.
Unlike new commercial insurance products, which consumers can purchase through March 31, there's no deadline to sign up for Medicaid. By the end of the year, state officials expect about 350,000 new users to be enrolled in the program.
The growing backlog is causing concern among health care providers worried about getting paid, and confusion, frustration and anger among consumers, whose coverage was supposed to begin in January.
Much the same thing is happening in New Jersey, the Star-Ledger reported last week.
By all accounts, enrollment in the expanded Medicaid program has gone well in New Jersey. The numbers are robust as the program's expansion under the Affordable Care Act allows single residents and childless couples to get coverage provided their income is low enough. But getting an actual ID card that allows someone to see a doctor? The flood of applicants appears to have resulted in a systemwide backlog, according to applicants and field workers.
"I've heard getting an actual Medicaid card is nearly impossible. It's like getting Willy Wonka's Golden Ticket," said Rena Jordan, director of external affairs for Planned Parenthood of Metropolitan Jersey, which has been helping patients enroll.
"A lot of strange things have been happening, that's the easiest way to say it," said Virginia Nelson, administrative supervisor of the Medicaid Department for Middlesex County.
The flood of phone calls to her office about older cases has taken time away from processing the newest cases, Nelson said.
Federal officials conceded some of the blame for the delay can be put squarely at the feet of the federal website, healthcare.gov. That website transferred data about applicants whose income looked like they might qualify for Medicaid to the state system, but in a format the state system couldn't use.
And in California, the backlog now numbers 800,000 for Medi-Cal, the state's Medicaid program, the Los Angeles Times reported this week.
One patient wrote The Times to say she has a worrisome growth behind an ovary. She submitted an application in October. County health clinics informed her she won't be able to keep her appointments for blood tests and ultrasound scans until her Medi-Cal coverage is confirmed, she said. Or she can pay full price for the services.
As of Thursday, she was still waiting.
"A lot of good, smart people with good intentions in the state and county are working really hard to fix these problems," said Katie Murphy, managing attorney at Neighborhood Legal Services of Los Angeles County, which has a grant from the state to provide legal assistance to patients with Obamacare enrollment cases. "But until they do, people will fall through the cracks."
A state spokesman told the paper that "the volume of Medi-Cal applications, combined with challenges of new computer systems, hampered the state's ability to complete eligibility reviews in a timely and accurate manner."
Matt Salo, executive director of the National Association of Medicaid Directors, said many of the problems relate to the way HealthCare.gov transfers information to states about consumers who appear to qualify for Medicaid based on their incomes. But there are state-specific issues, as well.
"It's been the number one issue of concern for our members for the past nine months or so," he said in an email. "The problems are getting fixed, but what worries people is that we're only a few months away from NEXT year's open enrollment, so we have to hurry."
While Star Sports has accused the MSO of violating TRAI regulations by not informing customers in advance before offering its channels on a-la-carte basis, Hathway says it followed all the rules and regulations
A full blown war of words is out between Star Sports and Raheja group-owned multi-system operator (MSO) Hathway. According to Star Sports, the MSO removed signals of sports channels from Hathway packages and offering customers more expensive pick and choose option. Star Sports, in fact even advised its viewers to shift to direct to home (DTH) if they are unable to see its sports channels. The campaign hit a peak during the just concluded T20 World Cup.
"We are of the opinion that they have violated the quality of service regulation framed by Telecom Regulatory Authority of India (TRAI). Especially for Delhi and Mumbai, Hathway failed to inform consumers about change in composition of packs, when they were bound to inform consumer through running of scrolls on its screen and publish a prior notice in leading newspapers," a Star Sports spokesperson said.
While Star Sports accused the MSO of violating TRAI regulations by not informing customers in advance before offering its channels on a-la-carte basis, Hathway hit back by saying it has followed all the rules and regulations of the regulator.
Denying the allegation, Hathway managing director and chief executive Jagdish Kumar G Pillai said, "We have followed all rules and regulations of TRAI...We have removed Star Sports from our existing packages and giving options to consumers to choose a channel or a package."
The dispute started after Hathway, a leading MSO with over 11 million subscription base in 140 cities removed Star Sports bouquet of four channels from its regular package and asked its viewers to pay a-la-carte to subscribe.
When asked the reason for putting Star Sports channels on a-la cart basis, Pillai said: "We have been paying them on a fixed pay basis, which worked out to be a very unreasonable amount on a 'per subscriber' basis".
However the Star Sports spokesperson said: "We were in the midst of negotiations and wanted to understand Hathway's future plans but they unilaterally went ahead and changed the composition of packs".
Star Sports and Hathway had entered into a fixed fee deal to add the broadcaster's channels in a package without any linkage to the subscription base.
According to Star, the parties had signed two separate agreements. While the first contract expired on October 31, 2013 catered to Delhi and Mumbai markets, the second contract expired in March 31, 2014 was for the places where digital addressable system (DAS) were notified by the government in the phase II of the digitalisation and Kolkata region.