State Medicaid Agencies Reporting Problems In New Exchange-Linked Enrollment System

Stay ahead of developments in federal and state health care law, regulation and transactions with timely, expert news and analysis.

By Ralph Lindeman  

Oct. 8 --Most state Medicaid agencies are reporting a rocky start to the Oct. 1 launch of a new eligibility and enrollment system that is linked to online state health insurance marketplaces, the head of the National Association of Medicaid Directors (NAMD) said Oct. 8.

“We've been predicting for months that the first few days of the rollout were going to be very bumpy, and so far things have gone as we've expected,” Matt Salo, NAMD's executive director, told Bloomberg BNA in an interview.

Under the Affordable Care Act, eligibility and enrollment for Medicaid is required to be handled through the new marketplaces, or exchanges, in what ACA supporters said would be a seamless, one-stop, no-wrong-door application process.

On Oct. 1, the exchanges began to enroll the uninsured for coverage that will begin Jan. 1, amid reports of widespread problems .

Medicaid Enrollment Begins on Exchanges

With respect to Medicaid, the ACA also required all states, beginning Oct. 1, to handle enrollment for people eligible for Medicaid on an exchange created by the state or--for states that did not create an exchange--one operated by the federal government.

In addition, beginning Jan. 1, the ACA expands eligibility for Medicaid. So far, 24 states and District of Columbia have decided to participate in the Medicaid expansion. They will also handle enrollment and eligibility for people newly eligible for Medicaid under the ACA's expansion.

Salo said states have experienced problems with Medicaid enrollment on the exchanges “across the board.” He said this applied “whether they are operating their own exchange, having the federal government run their exchange, expanding Medicaid or not expanding Medicaid.”

Shift From Paper-Based System

The primary challenge for state Medicaid programs in converting to the exchange-linked enrollment system was moving from what, in most cases, was a paper-based system to an online system, Salo said.

“It's important to stress just how massive an undertaking this was from an IT perspective,” he said. “It's unprecedented. The startup for Medicare Part D, which was relatively simple, had a lot of bumps. This is 100 times more complicated.”

At the same time, Salo said, most Medicaid directors were taking the early glitches in stride. “From our standpoint, none of this is earth shattering or surprising,” he said. “It's a road bump in what will be a long journey.”

Weekly Snapshot Reports on Implementation

NAMD has started compiling weekly “snapshots” of ACA implementation in the states, Salo said. NAMD staff conduct phone interviews with Medicaid officials in 15 to 20 states each week to assess what is happening with respect to ACA implementation.

With respect to the new enrollment system in the states, the snapshot covering Oct. 1-7 said, “Although there were some service slow-downs or technical glitches, these were transitory and states worked quickly to address them.”

It added: “Several states reported there was a dramatic uptick in volume to websites and call centers, and they were able to handle the increase. Others successfully launched only portions of their systems this week--with other components to be phased-in over the coming weeks.”

The snapshot also reports delays in states being able to process Medicaid applications due to connectivity problems between the exchange and a federal data hub, which is supposed to verify eligibility criteria, such as income and citizenship.

“Among states using the hub, there were some reports that connectivity was limited and sporadic in the first day or so, while others had not received any response from the federal data hub,” the snapshot said.

In addition, states relying on an exchange operated by the federal government have been informed by the Centers for Medicare & Medicaid Services that they will not receive Medicaid applications processed by the exchange until November, according to the snapshot.

Problems Related to Shutdown

Other problems reported in the snapshot were related to the government shutdown, which began Oct. 1, the same day the new enrollment system started. These included delays by the CMS in processing state waiver applications, as well as other implementation issues, Salo said.

“CMS is continuing its daily 'touch-base' calls with Medicaid agencies,” Salo said. “But CMS is now down to a skeleton staff, with many of the people who had been dealing with states now furloughed, so it's sometimes hard for the state people to know who to go to with questions.”

Salo said almost all CMS personnel in the agency's regional offices have been furloughed during the shutdown.


To contact the reporter on this story: Ralph Lindeman in Washington

To contact the editor responsible for this story: JoAnn Goslin at

Request Health Care on Bloomberg Law