Medicaid limbo catches 31,400

Care, doctors’ pay on hold as 45-day deadline broken

As of Aug. 2, as many as 31,400 Arkansans had been waiting longer than the maximum time allowed for word that their applications for Medicaid had been approved, according to numbers from the state Department of Human Services.

Federal rules allow a maximum of 45 days for state Medicaid agencies to process applications.

Some of those applications have been pending since last year, according to an Arkansas Medical Society official.

The delays have been widespread among mothers seeking coverage for newborns, said David Wroten, executive vice president of the medical society.

Meanwhile, some clinics have tens of thousands of dollars in unpaid claims, he said.

"The majority of physicians that we're aware of, they've just sucked it up. They're just doing it," Wroten said. "It's kind of like the state Medicaid program is borrowing on our dollar."

A Human Services Department spokesman said the lengthy delays in approving applications can be attributed to problems with the program's computerized enrollment system, along with a shift in staff time to eligibility reviews of current recipients.

Applicants who have been waiting longer than 45 days can request an administrative hearing.

Lack of functionality

Under federal regulations, a child born to a Medicaid recipient is automatically eligible for coverage for a year after the birth as long as the child lives with the mother and she remains eligible.

But because of a lack of functionality with the enrollment system, Human Services Department spokesman Amy Webb said, the department has had to process manually applications for the coverage, resulting in delays.

Progress on the system allowed the department to recently switch to using a one-page form, instead of a full Medicaid application, to add newborns to the program, she said.

Once an applicant is approved for coverage, Medicaid will pay for medical expenses incurred up to 90 days before the application was submitted, as long as the applicant was eligible during that time, she said.

The backlog of applications should be reduced, Webb said, as more newly hired caseworkers are trained and the department continues to make improvements to the enrollment system, which has been under construction since 2013.

"When we are made aware of specific cases that are urgent, we move them up and process them as quickly as we can," Webb said in an email.

Heidi Widder, 35, was already covered by Medicaid when she gave birth to her daughter, Anabella, on Jan. 5. With the help of hospital staff members, she applied for coverage for her daughter soon after the birth.

When Widder checked on the application, she said, a Human Services Department worker told her that the proof of income she had submitted was insufficient. After she submitted additional records Jan. 22, she said she checked again and was told the application was in "technical support."

Widder said she began checking on the application every week and got the same response.

While she waited, her daughter missed recommended checkups and immunizations. Without coverage, Widder said, she couldn't afford to take her to the appointments.

It wasn't until late June, after Widder contacted Jonesboro-based Legal Aid of Arkansas and requested a hearing on the application, that she learned it had been approved.

"It's been a major battle," Widder said. "It doesn't seem like it should be."

Others affected

In addition to coverage for newborns, the delays have affected applicants for the private option, ARKids First and other Medicaid programs that also are governed by eligibility rules that went into effect Jan. 1, 2014, under the 2010 Patient Protection and Affordable Care Act.

Applications for those programs are being processed by the new enrollment system.

Because the system is not yet fully functional, a "majority of the cases that are going through are requiring manual work on the part of the caseworkers," which adds to the processing time, Webb said.

At the same time, she said, the department has been working to catch up on reviewing the eligibility of hundreds of thousands of Medicaid recipients who have been signed up for at least a year.

Originally expected to begin last fall, the eligibility review was delayed until mid-May because of difficulties the department encountered in building the new system.

The income review was halted on Aug. 21 after officials with the federal Centers for Medicare and Medicaid Services said they would be issuing "changed guidance" about the department's practice of giving Medicaid recipients 10 days to respond to requests for income-related records, Webb has said.

The eligibility reviews will resume after the department's notices have been revised to give recipients 30 days to provide the records, she said.

'Pulling teeth'

Horace Green, a pediatrician in Pine Bluff, said his clinic is owed about $20,000 in Medicaid reimbursement for checkups and other services provided to infants with pending Medicaid applications.

To get their children immunized, parents whose children lack Medicaid or other coverage are referred to the state Department Health, which will administer the vaccines at no charge.

But Green said not all parents end up taking their children to get the shots. As a result, he's noticed more children who are behind on their vaccines.

"I know for a fact that a lot of children have slipped through the cracks," Green said.

He added, "If it's a sick child, we are not going to refuse them care because they don't have their insurance coverage but there's more and more of that that we're not getting paid anything for, and we can't keep doing that and stay open."

The Fayetteville-based Medical Associates of Northwest Arkansas has yet to receive payment for $125,000 worth of services provided since December to about 600 infants whose Medicaid applications are pending, Jason Wilson, chief executive of the physician group, said through a spokesman.

Janelle Turpin, 25, of Conway, said Wednesday that she's still waiting for word on the application for ARKids coverage she submitted in May for her 2-year-old son, Jack.

In July, she contacted the Center for Arkansas Legal Services in Little Rock, which helped her request a hearing on the matter. That hearing is set for Tuesday, she said.

"It's been a struggle this whole time," she said. "It's pretty much like pulling teeth."

Fuzzy numbers

The figures showing the number of applicants waiting longer than 45 days at the beginning of August were prepared at the request of the federal Centers for Medicare and Medicaid Services, Webb said.

The number could have been fewer than 31,000 because some applicants could have submitted multiple applications, she said.

The Human Services Department is supposed to provide monthly figures on application-processing time to the federal agency, but the enrollment system is not yet able to generate such reports.

The Aug. 2 figures were prepared by an employee who figured out a "temporary way to get the information," she said. That employee no longer works for the department, she said.

In a lawsuit filed Aug. 26, Legal Aid of Arkansas contends the Human Services Department did not fully comply with requests the organization made on May 27 and July 20 for records on possible delays in processing applications.

Webb said that the department has since given Legal Aid of Arkansas the Aug. 2 figures on pending applications. Those figures weren't available at the time Legal Aid made its requests, she said.

The Center for Arkansas Legal Services and Legal Aid of Arkansas receive federal funding to provide legal help to the poor. The Center for Arkansas Legal Services serves 44 counties, including Pulaski County. Legal Aid of Arkansas serves the other 31 counties.

Between May 1 and Aug. 26, the Center for Arkansas Legal Services received calls from 51 Medicaid applicants who had been waiting more than 45 days for a determination on their eligibility, said Julie Howe, an attorney with the organization.

One woman applied in January for coverage of her expenses related to pregnancy and childbirth. Last month, she had the baby, but still hadn't received word on the application, Howe said.

In such cases, she said, her organization requests an administrative hearing.

"About 90 percent of the time," the hearing request results in the Human Services Department manually processing the application and finding the applicant eligible for coverage, she said.

But Howe said many applicants likely don't know they can request a hearing.

Webb said the department plans to notify applicants of their right to request a hearing.

"We're aware that there are people" whose applications have been pending for more than 45 days, Webb said. "It's an issue that we want to address as well."

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