At least 2.9 million Americans who signed up for Medicaid coverage as part of the health care overhaul have not had their applications processed, with some paperwork sitting in queues since last fall, according to a 50-state survey by CQ Roll Call.
Those delays — due to technological snags with enrollment websites, bureaucratic tangles at state Medicaid programs and a surge of applicants — betray Barack Obama’s promise to expand access to health care for some of the nation’s most vulnerable citizens.
As a result, some low-income people are being prevented from accessing benefits they are legally entitled to receive. Those who face delays may instead put off doctors appointments and lose access to their medicines, complicating their medical conditions and increasing the eventual cost to U.S. taxpayers.
Democratic lawmakers who have promoted the law’s historic coverage expansion are wary of acknowledging problems that hand opponents of the Affordable Care Act another rhetorical weapon, said Robert Blendon, a professor at Harvard University School of Public Health and Kennedy School of Government.
“Any problem plays against the Democrats,” Blendon said.
Meanwhile, Republicans usually eager to criticize the Obama administration or states for implementation problems risk looking hypocritical by showcasing the Medicaid waits. Many oppose expanding the program to people with incomes as high as 138 percent of the federal poverty line, as the law allows states to do, and are loath to demand more efficient enrollment to achieve that goal.
“It’s a total contradiction in terms to spend your public time castigating Medicaid as something that never should have been expanded for poor people and as a broken, problem-riddled system, and then turn around and complain about the length of time to enroll people,” said Sara Rosenbaum, a member of the Medicaid and CHIP Payment and Access Commission, which advises Congress.
Medicaid is a joint federal-state health program for the poor seen as a linchpin to expanding health coverage under the 2010 law (PL 111-148, PL 111-152).
Eligibility for the program is determined by federal and state guidelines, with the administration of the program left to the states. People enroll for Medicaid through federal or state websites or use other avenues, such as filing paper applications.
Aaron Albright, a spokesman for the Centers for Medicare and Medicaid Services, said the government tried to help states anticipate the workload from the coverage expansion through steps such as weekly data releases showing how many residents appeared to qualify for Medicaid. He said the agency is busy transferring data to those states equipped to process the information.
“CMS is actively transferring accounts to all states that are ready to receive them,” Albright said in an email. “In the meantime, every state not receiving transfers can be enrolling people through alternative options CMS has made available.”
Variety of Problems
Forty-one states as of May 29 responded to requests from CQ Roll Call about the number of pending Medicaid applications, the number of individuals covered in the applications and processing times. The remainder, including Missouri and New Mexico, didn’t respond to CQ Roll Call’s emails and phone calls for enrollment data.
United We Dream protesters carry a mock coffin to the office of Sen. Ted Cruz, R-Texas, in the Dirksen Senate Office Building on Monday, July 21, 2014, to hold one of their "funeral services for the Republican Party" due to GOP positions on immigration. The immigration reform group visited several other Senate Republican offices to hold similar funeral services.