Despite a legislative impasse over Medicaid expansion, a Department of Health and Social Services division is working to eliminate a longstanding backlog of Medicaid applications across the state by July, the deadline Gov. Bill Walker’s administration gave early on for expansion.
That won’t be easy. There are 9,175 applications “out of time frame,” meaning they’ve been waiting to be processed for more than 30 days, said acting Division of Public Assistance Director Ron Kreher.
Some Medicaid applications submitted by low-income residents waiting for coverage through the state are from before October 2014.
That number is down from 9,239 from a couple weeks ago. When work started in January, there were a little less than 10,000 outdated applications waiting, Kreher said.
The crew is “working this body of work from both ends,” tackling the newest and the oldest applications first, because “when the day goes by another application slips into backlog status,” Kreher said.
Between January and March, Kreher’s team logged more than 100,000 hours of overtime — some voluntary, some mandatory — processing Medicaid applications, he said. In February, the staff got through 10,000 of them.
“That’s a heap of work, especially for a short month,” he said. “That’s essentially doing almost 400 eligibility determinations a day. … In order to be prepared for expansion, we’re trying to eliminate the backlog.”
In March, the division got through 11,000 applications. As of last month, 121,955 Alaskans, including 3,804 Juneauites, were enrolled in the federal health care program, according to DHSS numbers.
The department anticipates 20,000 more Alaskans would enroll in the first year of expansion, which would include those who make up to 138 percent of the poverty level (about $20,000 a year for a single adult).
Despite an anticipated increased workload, Kreher said he thinks the division, which also processes applications for the state’s food stamp and Denali KidCare programs, among others, will be able to handle the added strain on its resources.
The division has cleared the decks of 300 eligibility technicians in order to make the July deadline, he said. On top of that, another 60 people from within the division and more from other offices in the department have been helping get through the applications many of which are turned into one of 17 offices in paper form.
“We’ve been able to fund voluntary overtime so we’ve got well over 330 or so people who are helping us out,” Kreher said.
Between December and March, DHSS spent $825,000 on voluntary paid overtime to get through the pending applications.
“In this budget environment it’s not likely” the division will be able to hire more employees to take care of the backlog in anticipation for expansion, Kreher said.
Still, “I’m very confident we’ll be able to handle the flow of work through expansion,” he said.
The federal government does not have data on states’ ability to keep up with application backlogs once they expand Medicaid.
Of the 29 states (plus Washington, D.C.) that have expanded Medicaid, most “have no backlog,” according to the federal Centers for Medicare and Medicaid Services.
“Most states that we reached out to recently have cleared their backlog or have substantially reduced their backlog, and are on a path to ensure timely enrollment,” said CMS spokesman Jibril Boykin in an email.
When asked which expansion states are still working to clear up a backlog, he said “CMS does not have this type of information available.”
The Kaiser Family Foundation, which also keeps data on Medicaid expansion, did not respond to a request for information on state backlogs.
Roughly 42 percent of Alaska’s Medicaid applications are being processed within the state’s 30-day time frame, Kreher said. The average out-of-date application is 120 days old, but “a lot of those applications are from before October” 2014, when the state went live with a new Medicaid application processing system — a program glitch makes the ages of old applications iffy, he said.
The saga of getting the new processing system live is one of many reasons the division is constantly playing catch-up, Kreher said.
Alaska’s Resource for Integrated Eligibility Services, or ARIES, is the computer program technicians use to determine eligibility. It went live in October 2014, a year after it was supposed to, Kreher said, and after 20 months of development. It cost the state $22 million, but almost $20 million of that was federal money.
ARIES was supposed to be online in October 2013, when the Affordable Care Act’s online health insurance marketplace went live. But, for a variety of reasons, that didn’t happen, Kreher said.
“Almost for a year we were having to do these complicated eligibility determinations manually,” he said. “That really stretched the amount of time it took to do these applications.”
Work slowed down further as technicians encountered complicated combined family structures that required multiple manual eligibility determinations, Kreher said.
“Multiple tax filing units, which is not uncommon, adds to the level of effort,” he said. “It literally tripled the amount of time, … other work was held up. As soon as you start to create a backlog of work it grows really quickly.”
The division worked to clear out the piling applications. In June 2014, “we had a moment of relief. … We had pretty much eliminated much of the backlog,” Kreher said. “Staff was taking annual leave.”
But that didn’t last long, he said. The division was “getting massive amounts of (application) transfers” from the federal online marketplace — “2,000 to 3,000 of these account transfers all at once.”
“For reasons I have still not sussed out, the backlog started to creep up on us again,” Kreher said. “Because the system still had not gone live, we were still dealing with this manual process. In the subsequent three months, another backlog started to creep up and staff had been on overtime and we had to impose mandatory overtime.”
Once AIRES was ready to go, staff needed to be trained on the program, Kreher said. Employees had to stop determining Medicaid eligibility to get comfortable with the new system.
Once they finished training, “then you don’t get a lot of productivity out of them for a month” as they’re learning the ropes, Kreher said.
“The backlog was created by a strain on our resources,” he said. “(Technicians) couldn’t get more work (done) and we couldn’t request more people to do the work. …
“It was kind of like a Lemony Snicket book – ‘A Series of Unfortunate Events.’”
Some of the backlog can be attributed to user error — about 30 percent of the paper applications the division receives in its 17 offices around the state are incomplete and must be sent back to the applicant to be finished.
The applications are mailed in and dropped off by applicants and submitted by hospitals and clinics who help people fill them out. Bartlett Regional Hospital helps about 500 people per year complete Medicaid applications, spokesman Jim Strader said. The Front Street Community Health Center declined to comment.
“We get them from all sorts of places,” Kreher said. “Depending on the nature of the source it can impact, if you will, the completeness of the application. … If we get an incomplete application, we can’t act on it.”
“Incomplete” can mean anything from a missing social security number or address to a blank page or two.
“It’s not uncommon for people to forget to even sign the thing,” Kreher said.
The application then must be sent back to the applicant so it can be completed and turned in again.
“A general rule is we get an application, it’s reviewed, it’s acted on as quickly as possible,” Kreher said. “At the very least we give 10 days (for the applicant) to respond.”
The division’s workload is not split up by geographic area, Kreher said, so where you live doesn’t determine how long it will take for your Medicaid application to be processed. But of the 17 offices, Fairbanks has the biggest backlog of applications, he said.
The division is working against the clock to be ready for expansion — if it happens. Gov. Walker made Medicaid expansion his No. 1 priority during his campaign and has said he will most likely call a special session of the Legislature to continue to push his legislation. Push back is coming from lawmakers who demand Medicaid reform before expanding the program.
Walker’s staff have answered questions in more than 20 legislative committee hearings on Medicaid expansion since the start of session.
“We’re basically deploying any and every (method), so we’re ready when Medicaid goes live this summer to have the decks pretty much cleaned out,” Kreher said.