Medicaid cases backed up by NC FAST migration

mhankerson@newsobserver.comMay 20, 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.

For two months, Lillian Croom struggled with her 6-year-old son, Ryan, as she tried to ration medication he needs for several behavioral disorders.

Croom uses the state’s Medicaid system and learned Ryan’s coverage lapsed as the state and county work through a backlog of Medicaid applications.

Croom’s son is on medication, but it costs $400 a month and there is no generic option.

“Unfortunately, I’m afraid this is one of those situations where ‘going without’ isn’t a very feasible option for us,” Croom said.

Wake County Health and Human Services referred Croom to Urban Ministries when she told them Ryan’s medicine was critical to her family’s functioning.

Urban Ministries was able to provide half a month’s supply of the medication, so Croom had been spacing out when she dispenses the medicine to her son.

Last Friday, Croom had 10 pills left in her son’s prescription when his coverage was finally restored.

Croom recently found out her son’s insurance lapsed for the same reasons she had to make do without nutrition assistance for six months last year: a snag in a new system meant to streamline the process of receiving benefits from the state.

NC FAST program at fault again

Two months after clearing a backlog that threatened federal funds to help administer food stamps, North Carolina is falling behind again in moving Medicaid benefits to its new NC FAST program.

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

With 60,000 people across the state whose cases are part of the Medicaid backlog, 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 (which include the 12,000 overdue ones), with 5,797 of those coming from the Federal Marketplace.

Across the state, there are 94,719 Medicaid applications that are past normal processing time. 37,507 of those have come from the Federal Marketplace.

“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.”

A waiver issued by the federal government to the state was supposed to prevent the loss or lapse of coverage- it said recertification could go through the state’s old system, avoiding coverage lapses- but if the waiver protocol was not applied to a case, it’s possible that the benefit was suspended, Glaser said.

Recertification is a process that happens every six months to a year to renew Medicaid coverage. According to Scott, the county has between 9,000 and 10,000 recertifications due every month, 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 recertifications with their current staff.

Glaser said that problem is another example of things getting lost in the system, which the county is not sure how to fix yet.

For right now, there is no other solution for the county but to work through the thousands of applications and prepare for the future, which could be more applicatons coming in during federal open enrollment periods.

Right now, county employees are manually entering Medicaid cases into the NC FAST system. The number of cases they enter also include applications from the federal marketplace established by the Affordable Care Act.

Glaser said the county has a tentative goal to try to clear the Medicaid backlog by Oct. 1, 2014.

Complications from new law

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

When the Affordable Care Act’s federal marketplace opened in November, about 73,000 of North Carolina’s applications were from people who may be eligible for Medicaid coverage, the Kaiser Family Foundation reports.

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

According to North CarolinaDepartment of Health and Human Services Press Assistant Kirsti Clifford, the state was ready to receive those applications on Oct. 1, but the federal system was not ready until Jan. 16, 2014 when applications came in “sporadically.”

Clifford said the state is still waiting for 15,000 more applications from the Federal Marketplace.

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

Looking for help in county budget

Scott said the department is preparing for a heavier caseload, a trend that the department has dealt with since the economic recession.

And now, with the federal marketlplace also feeding applications to the county, Scott said it’s not clear how much more that will add to the caseload, but it may get tough during open enrollment periods.

“That’s something we'll have to plan for (but)I dont think we’ll see qute the level we saw in the first year,” she said.

In a request to county commissioners in February, Scott said the department would need $288,997 for the remainder of this fiscal year from the county to keep up with applications for various benefits.

At that time, Scott told commissioners she predicted the department to need the equivalent of 26 additional full-time staff members for Medicaid implementation in the NC FAST system.

The request included 26 case managers, three supervisors, one program manager, two administrative staff members and four trainers, which would need to be added immediately.

A draft of the county budget is expected to presented on Monday, May 19.

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

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