The problems are most acute in three states — California, Illinois and North Carolina — where almost 1.5 million Medicaid applicants remain in limbo. Though all three are experiencing high volumes of enrollment, problems vary from California’s balky electronic sign-up system to Illinois’ inability to predict a surge of applications.
The waits are linked in part to the troubled rollout of the federal insurance website healthcare.gov last fall. Alaska, Kansas, Maine and Michigan still are unable to receive applications their residents completed through the federal website. Others such as Georgia received applications submitted last fall in May.
“These people were encouraged to seek help, and they didn’t get it,” Blendon said.
Beyond the individuals, the delays have left doctors, hospitals and other health providers unsure whether they will be reimbursed for care they provide to people who appear eligible for Medicaid but haven’t received benefit cards.
“It’s a huge systemic issue right now,” said Rosenbaum.
The delays are caused by a mix of technical problems and a surge of applications, especially in states that cajoled their residents to sign up for newly expanded benefits. More than 900,000 Californians are waiting for their benefit cards or denial letters, say state officials. In Illinois, another 330,000 people are in limbo. In North Carolina, it’s 285,884, plus another 12,956 applications that may include more than one person.
Norman Williams, a spokesman for the California Medicaid system, said the situation is “not something we are satisfied with.”
He said people still waiting for coverage decisions could go to local hospitals that can expedite their enrollments and, in many cases, provide temporary benefit cards.
“It’s not an easy situation for them,” he said. “We certainly understand that. That’s why we have this sense of urgency to get this done and get them into coverage.”
Supporters of the law note that Medicaid benefits are retroactive. If an eligible person received care while waiting to be enrolled, the program would pay for services dating back 90 days before the person applied, although some states make applicants specifically request retroactive coverage. But people with applications in the queue may not be aware of that requirement and have no guarantee that states will agree they qualify for Medicaid.
States are supposed to process Medicaid applications within 45 days. Several reported that they are largely meeting those guidelines. Some, including Colorado, Iowa and New York, significantly sped up processing this year.
Others expect federal exemptions for “unusual circumstances.” In Virginia, which first got a trickle of applications from healthcare.gov in late February, 45 percent of applications are past the 45-day limit.
Many states that relied on healthcare.gov to handle applications as well as states that built their own websites are wrestling with backlogs.
In the 36 states whose residents signed up through healthcare.gov, at least 1.4 million people faced delays because the website was unable for months to transmit the information to states. Once it did, states complained they weren’t receiving all of the applications and that data was incomplete or riddled with errors.
Vice President Joe Biden waits to conduct a mock swearing-in ceremony with Sen. Brian Schatz, D-Hawaii, in the Capitol's Old Senate Chamber, December 2, 2014. Schatz was sworn in to serve the remainder of his term since he was appointed to the seat after Sen. Daniel Inouye, D-Hawaii, passed away.