On Black Friday, Administration Tried To Bury Medicaid “Fix” That Threatens Program, Presents Challenges to States

December 3, 2013

File This Under: The Administration Wanted You to Miss It

The administration delivered not one but two holiday-weekend news dumps last week. Politico reports, “An Obamacare fix quietly announced on Black Friday could put states at risk for higher Medicaid costs and even fraud.” In a shameless attempt to slip another health law delay past Americans spending time with their loved ones, “the Obama administration agreed Friday to let states use an incomplete set of data – known as a ‘flat file’ – to enroll people in Medicaid, even though those files lack critical information that sates normally use to verify eligibility.”

Energy and Commerce Committee leaders wrote to Centers for Medicare and Medicaid Services Administrator Marilyn Tavenner in late October regarding the Medicaid eligibility verification delay. Committee leaders wrote, “We write to request the most updated information on the timing of account transfers to states, including responses to these specific requests which seek to ensure the program is protected from any hurried eligibility determinations or improper enrollment due to rushed timelines and flawed operations.” As Politico explains, the administration’s Friday announcement, “comes with big risks for states, and it’s up to them to decide whether they’re willing to risk the integrity of their Medicaid programs to sign people up faster.” The committee is still awaiting a response to the October 24 letter.

December 3, 2013

Medicaid, Insurance Fixes May Be Big Trouble Later

An Obamacare fix quietly announced on Black Friday could put states at risk for higher Medicaid costs and even fraud.

Although Medicaid sign-ups through HealthCare.gov have been considered a rare bright spot in the flawed Obamacare rollout, the federal portal has been unable to send those Medicaid applications to the states for final processing. If states can’t receive and complete their work on Medicaid applications by the end of the year, people could go without Medicaid coverage in early 2014 despite having an eligibility determination.

To circumvent the broken transfer process, the Obama administration agreed Friday to let states use an incomplete set of data — known as a “flat file” — to enroll people in Medicaid, even though those files lack critical information that states normally use to verify eligibility.

“We anticipate that the strategy … will enable states to ensure that eligible individuals have timely access to Medicaid and [Children’s Health Insurance Program] coverage in a simple and streamlined manner,” administration Medicaid chief Cindy Mann wrote in a letter to state Medicaid directors.

But the expedited enrollment process comes with big risks for states, and it’s up to them to decide whether they’re willing to risk the integrity of their Medicaid programs to sign up people faster.

“We are supposed to, as states, do our due diligence in signing up only people who are eligible,” Kathleen Nolan, state policy director for the National Association of Medicaid Directors, said Monday. “The letter is silent on what’s going to happen when it comes time to evaluate program integrity issues.”

States are concerned that many of the flat files they’ve received from HealthCare.gov don’t indicate whether applicants have also attempted to enroll in Medicaid directly through a local agency, leaving states vulnerable to duplicate sign-ups. And there’s been no end-to-end testing to gauge potential issues with the information states get. Complicating the issue further is the work many states are doing to rebuild their own Medicaid eligibility systems to align with new Obamacare requirements.

The processing problems parallel the HealthCare.gov challenges faced by private insurers, who have complained of receiving inaccurate enrollment files — known as 834 forms — from the website. The Obama administration, which has repeatedly insisted that fixing the 834 process is a top priority, on Monday claimed big improvements on this front during the past week. …

Read the complete story online here.

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