Roughly 27,000 poor Georgians, most of them children, still don’t know whether they’ll get health coverage months after applying for Medicaid through the Affordable Care Act’s health insurance marketplace.
Earlier this year, HealthCare.gov determined roughly 89,000 low-income Georgia residents qualified for Medicaid. But the federal computers could not communicate properly with the state’s computers, leaving the majority of those applicants in the dark for months about whether they would actually be enrolled in the program.
Federal regulators warned Georgia’s Medicaid agency in July that they planned to investigate the “substantial backlog” of applications. The state has since managed to process 70 percent of the applications, with about 31,000 people now receiving benefits. About the same number who were initially determined eligible for the government health program by the marketplace ended up being denied coverage after further review of their records, said Pam Keene, a spokeswoman for the Georgia Department of Community Health, which administers Medicaid.
“Georgia Medicaid has now completed database checks of all of the account transfers and determined eligibility status for them or that additional information from the applicant is needed to complete evaluation,” she said.
It’s unclear when the state will make final determinations on the tens of thousands of applications still stuck in limbo, according to Keene.
The delay has been frustrating for families trying to enroll and those trying to help them navigate the process.
“It’s unfortunate,” said Monique Winters, a community resource specialist at Mercy Care Atlanta who has helped enroll dozens of people in the federal marketplace. “The children are the ones who are affected the most, and it just takes extra time to keep going back and back.”
Nationwide, Georgia has one of the largest numbers of children who are Medicaid-eligible but still uninsured.
“We know that they have limited resources, but at the same time, there are people who enrolled and still don’t know their status,” said Cindy Zeldin, executive director of the nonprofit Georgians for a Healthy Future, an advocacy group. “This is a really big opportunity to reach a lot of unreached kids, so it seems like it’s been a missed opportunity.”
It also is a missed opportunity to keep healthcare costs lower for all Georgians, said Tim Sweeney, director of health policy at the Georgia Budget & Policy Institute.
“The healthcare system is funded by everybody, and costs are passed around,” Sweeney said. “High uninsured rates mean more hospital visits, more costs for hospitals, and they will make that up. We all end up paying in a less efficient way.”
The failure to quickly enroll Medicaid-eligible Georgians was an example of problems that millions have encountered with the federal marketplace, a key element of the Affordable Care Act. Transfer of information from one computer system to another was supposed to have been seamless, but it wasn’t.
“There were obvious glitches for states relying on the federal marketplace,” said Robin Rudowitz, a health policy analyst with the Kaiser Family Foundation, a non-profit organization that conducts health policy research. “It’s been a widespread problem.”
Rudowitz said she was encouraged that the state is making progress on processing the Medicaid applications.
She also said that the inability to transfer important information about qualifying for Medicaid was due to lapses on the state and federal level.
Hazel Mapp of Stone Mountain knows the hassle and anxiety only too well. Much to her surprise, the single parent learned in March that her teenaged son was eligible for Medicaid. Mapp sells real estate, but business isn’t as good as she needs it to be. Her only child, who takes AP classes and hopes to become a lawyer, wears glasses and wore braces. The costs were high.
“It was costing me a penny,” Mapp said, but she was able to work out a payment plan. “It was a struggle.”
She was thrilled and grateful to learn the family was eligible for help. Then came the frustrating delays. She managed with the help of Winters at Mercy Care, who managed a “work around” by enrolling the child in the state Medicaid enrollment system and bypassing the federal marketplace.
Now that her son is enrolled, the frustration is behind.
“The truth of the matter is that I’m relieved now,” Mapp said. “I thank God it has all worked out. I hope the same for the others.”