Medicaid cases backed up by NC FAST migration

mhankerson@newsobserver.comMay 21, 2014 

  • Without benefits?

    Liz Scott, Wake County Human Services assistant division director, said Medicaid applicants who are waiting on the county have several options, depending on an applicant’s situation.

    • If an applicant is experiencing a medical emergency, Scott said there is a process to expedite that application.

    • Regional centers should have lists of community partners who may be able to help with medical costs and care.

    • If applicants applied through the federal marketplace (healthcare.gov) and are not interested in receiving a subsidy for insurance, they can contact the Department of Human Services to withdraw their application.

    • Scott said there are instances in which cases are lost in the shuffle between the old and new system or the federal waiver protocol was not applied to retain benefits when re-certification came up. In that case, applicants can call the department’s call center for more information.

    • Medicaid is the only state insurance program that will backdate benefits. Recipients whose coverage has lapsed should keep documentation of any medical costs they incur while not covered. The state can later reimburse them once the backlog is cleared.

— Around this time last year, Knightdale resident Lillian Croom went six months without food stamps for her family of four.

This year she spent two months struggling to ration her 6-year-old son’s medicine after he lost his insurance through the state’s Medicaid program. In both instances, the problem was the same: a snag in moving to a new computer system that was supposed to streamline the process of receiving benefits from the state.

Ryan Croom, who is developmentally delayed, has severe behavioral disorders, which make him violent and unmanageable without medication. Urban Ministries bought a half-month supply to help, and his mom started rationing. He was down to 10 pills when his coverage was restored last week.

Two months after clearing a backlog that threatened federal funds to help administer food stamps in the state, North Carolina has fallen behind again in moving Medicaid benefits to its new NC FAST program. Across the state, 94,719 people like the Crooms are part of the Medicaid backlog.

In a recent presentation to county commissioners, Wake County Human Services employees said the focus on clearing the food and nutrition backlog is one of the reasons Medicaid is now falling behind.

Kathryn Glaser, a public relations specialist with Wake County, said inadequate staffing, new technology and a shake-up by federal and state laws is complicating the implementation of NC FAST.

In Wake County, there are 12,000 overdue Medicaid applications. In total, the county has 14,989 applications pending, with 5,797 of those coming from the federal health exchanges established by the federal health law.

“When you put in a new system like NC FAST, of course that slows people down,” said Liz Scott, Wake County’s Human Services assistant division director. “There’s a learning curve, and there are still a few issues in the system.”

Federal waiver

A waiver issued by the federal government to the state was supposed to prevent a loss, or lapse, of coverage. It said re-certification could wait and people could keep their coverage. But if the waiver protocol was not applied to a case, it’s possible that the benefit was suspended, Glaser said.

Recipients must be re-certified every six months to a year to keep their Medicaid coverage. The county has between 9,000 and 10,000 re-certifications due every month, Scott said, but none of those are being touched because of the backlog of new applications.

Scott said on average, the department is able to process 6,000 of those re-certifications with their current staff. The department has asked for money to hire more staff in the budget now before county commissioners.

Glaser said the county has a tentative goal to try to clear the Medicaid backlog by Oct. 1.

Glaser said that even if the county can iron out the technological difficulties in the NC FAST program and the county approves money for more staff, more challenges could arise from the federal Affordable Care Act.

When the health law’s federal marketplace for people to shop for insurance coverage opened in November, about 73,000 of North Carolina’s applications were from people who may be eligible for Medicaid coverage, according to a Kaiser Family Foundation report.

North Carolina didn’t receive any of those applications to process until the end of February, meaning more than 5,700 applications poured into the county at the end of February, Scott said.

That number continues to grow as Medicaid applications trickle in to Wake and other counties.

Kirsti Clifford, a spokeswoman for the state Department of Health and Human Services, said the state was ready to receive those applications last Oct. 1, but the federal system was not ready until Jan. 16, when applications came in “sporadically.”

She said the state is still waiting for 15,000 more applications from the federal marketplace.

A county budget request

Clifford said state employees review the applications to make sure they’re complete before sending them to counties to try to reduce the workload.

Scott said the county has been dealing with a heavy caseload ever since the recession. Her department has asked county commissioners for $288,997 to pay for temporary staff and overtime for the remainder of this fiscal year to keep up with applications for various benefits.

She told commissioners the department would need the equivalent of 26 additional full-time staff members for Medicaid implementation in the NC FAST system.

Hankerson: 919-829-4826; Twitter: @easternwakenews

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