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For thousands of the District’s poor, Medicaid is the only thing preventing a financially catastrophic health event. But a new analysis by the D.C. Fiscal Policy Institute finds that glitches in the District’s application system for benefits and a significant backlog of existing applications could force many residents to go without health coverage if the issues aren’t fixed by early next year.
“D.C. rightly congratulates itself for having almost universal coverage with the uninsured rate at about five percent [of total population],” says Jennifer Mezey, a supervising attorney at the Legal Aid Society of the District of Columbia. “But the problem is that if you can’t reliably get access to insurance, then it doesn’t do you much good. We’re not saying D.C. doesn’t care about, or is being hostile to, our clients, but that these problems are real for low-income people.”
According to DCFPI analyst Wes Rivers, around 5,000 people have not been able to access Medicaid coverage while waiting for their applications to be processed this year; most of those cases have been pending for at least 45 days (a period within which states generally must process Medicaid applications to comply with federal guidelines). That’s in part due to the District’s well-intentioned efforts to modernize healthcare enrollment. Tech problems have created a backlog of a few thousand “malformed” cases, Rivers explains, whereby people have completed their applications but a glitch has scrambled their information.
Additionally, so-called “passive” renewals that began in January—and have helped roughly 37,000 households renew their Medicaid eligibility without having to visit social-services centers or complete paperwork—won’t continue again until next spring. A technology glitch, Rivers says, is preventing D.C. agencies from pinging federal databases to access beneficiaries’ information and use it to determine eligibility (which agencies are legally required to do before asking the beneficiaries themselves to take action). A separate glitch is also preventing individuals on Medicaid from renewing their benefits online, so they’ll have to complete applications by hand, then mail, fax, or physically bring them to service centers. More than 7,000 renewal cases could be affected by these glitches out of a total Medicaid population of more than 70,000.
“The application backlog won’t be fully processed until March,” Rivers says, based on discussions he’s attended through the D.C. Medical Care Advisory Committee. “Then you have the added pressure of all the renewal cases that will come through the door in January, making it difficult for [D.C.] to process anything in a timely way…Forty-five days is a long time to wait without healthcare.”
The Department of Human Services, which houses the Economic Security Administration that determines eligibility for various benefits, including Medicaid, did not immediately respond to a request for comment today.
The D.C. Department of Health Care Finance also did not respond to a request to weigh in on DCFPI’s analysis.
DCFPI worries that service centers will get hit with a difficult-to-manage number of in-person submissions for Medicaid come January, resulting in long wait-times, unsecured documents, or wrongful termination of benefits. DCFPI recommends that D.C. not cancel anyone’s Medicaid benefits until the IT problems are fixed; that it eliminate “unnecessary eligibility requirements” in other benefit programs to reduce traffic to the centers; and partner with local community health centers in the eligibility and enrollment process.
Update, 12/16/15: Claudia Schlosberg, senior deputy director at DHCF, said in a phone conversation that DCFPI’s analysis is overblown. “Statements suggesting that thousands of people would lose their Medicaid are speculative,” she said. “In the months that we have been using [the passive renewal] process, we have actually increased the number of people who stay connected to their Medicaid benefits. This is as a result of the combination of IT improvements but also a significant increase in the outreach we’re doing to beneficiaries.”
DHCF also provided a longer statement addressing the points raised in DCFPI’s analysis and citing specific data, which you can read below. After reviewing that statement, Rivers said he applauds DHCF’s outreach and tech-modernization efforts but “totally stands by the numbers and analysis we provided.”
Graphs via DCFPI