Posted: 6:04 a.m. Wednesday, Dec. 4, 2013
By Marissa Evans
After two months of media shellacking, healthcare.gov website woes and a series of skeptical congressional grillings, the Centers for Medicare & Medicaid Services (CMS) was accentuating the positive, noting the jump in the number of people eligible for Medicaid under the Affordable Care Act.
More than 1.46 million people were determined eligible for Medicaid or the Children’s Health Insurance Plan (CHIP) in October, according to a CMS report released Tuesday. The report is the first in a series of monthly reports to be released by the agency.
There was also an increase in the number of people applying for eligibility. In the states that opted not to expand Medicaid, October’s numbers were up 4.1 percent over the average for the previous three months. In states that were expanding Medicaid, applications were up 15.5 percent.
The federal health law called for an expansion of the joint-state federal health program for low income residents to all earning below 138 percent of the federal poverty level (about $15,900 for an individual in 2013). But the Supreme Court made expansion optional, and half of the states are not participating.
“We are encouraged by the 1.46 million people found eligible for Medicaid and CHIP in just the first month of open enrollment,” said Emma Sandoe, a spokeswoman for CMS, in a written statement. “The Affordable Care Act is making it easier for low-income individuals to get health insurance, by simplifying the system and allowing them to fill out one application to find out if they qualify for Medicaid or tax credits for private health insurance.”
The report highlights data from state Medicaid and CHIP agencies on individuals who applied for Medicaid during the first month of enrollment on new health care exchanges. However, in states that are expanding their Medicaid programs, the numbers do not distinguish “newly eligible” enrollees based on the Medicaid coverage expansion in the Affordable Care Act from those who were previously eligible for Medicaid. Although the report includes data from all states, the numbers don’t reflect people who applied or were determined to be eligible through healthcare.gov, the federal health exchange website, which is being used in 36 states.
California, which has its own Covered California exchange and the largest number of uninsured residents, had 149,098 new Medicaid and CHIP eligibility determinations, the highest number of the states expanding Medicaid. Among states not expanding their program under the Affordable Care Act and reporting Medicaid and CHIP eligibility numbers to CMS, Florida had the most new eligible individuals with 164,993 determinations.
But states face a tough decision for processing applications coming from the glitch-ridden healthcare.gov.
On Friday, CMS announced in a letter to state Medicaid directors that it will allow the use of a simplified Medicaid waiver submission and approval process for states, that relies on files known as “flat files” that don’t contain complete electronic data on individuals. This would allow states more quickly to enroll newly eligible people who applied through the federal exchange in Medicaid and CHIP so their coverage will begin on Jan. 1. States can apply for a waiver to use this option for up to three months with a possible extension depending on their circumstances.
For states deciding whether to do flat files, “it’s not just an easy check box,” said Andrea Maresca, director of federal policy and strategy for the National Association of Medicaid Directors. She said states are in different places with their systems and may have to make modifications to process information from flat files, devoting time, staff and resources for what’s supposed to be a temporary fix.
“It’s not something states can do quickly…it’s not something that can be done in a day,” Maresca said.
Another concern for states is the possibility of future penalties if they process incorrect information from healthcare.gov and sign someone up for Medicaid or CHIP who is not eligible.
“States have been told verbally on a call they are not held financially responsible for (federal marketplace) errors in the determination process but that’s not in writing,” Maresca said.
Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communications organization not affiliated with Kaiser Permanente.