Yakima County lags in Medicaid sign-ups

Dec. 09--Related Information

Washington state's online insurance exchange is wahealthplanfinder.org.

YAKIMA, Wash. -- As the federal healthcare.gov website flailed amid interminable wait screens and errors long after its Oct. 1 go-live date, Washington state touted its own insurance exchange as an example of what health reform looks like when it works.

Now, two months down the road, it seems the state website has not been as user-friendly as advertised -- at least not in Yakima County, where thousands of low-income people and their families are waiting for the medical coverage they were promised.

"I wouldn't say it works," said Christy Bracewell, vice president of managed care at Yakima Valley Farm Workers Clinic, which has 22 employees in Yakima County clinics enrolling people in health plans. "This week has not been a good week. It's been down a lot. And they still have a ton of error codes that they need to get through."

The state Health Care Authority last week released a chart showing how counties are doing on enrolling uninsured in Medicaid, the state-federal health program for the poor. Yakima County, with the highest uninsured rate in the state, was at the very bottom of the list, with 2,457 newly eligible people enrolled in Medicaid as of Nov. 28. The target had been 9,936 by Jan. 1.

Local health clinics have been working hard to enroll the newly eligible, so the poor standing was confusing. State officials and local providers attribute the result mostly to "circumstantial" factors affecting the Healthplanfinder website, where people go to determine eligibility and apply for coverage.

"We were probably as surprised as (Yakima providers) were that that's where they fell, because they've been so engaged and so on-the-ground going," said Mary Wood at the state office of Medicaid, Medicare, Eligibility and Policy. "We know they're doing good work there."

The main problem is the system's extreme sensitivity with identity data. It requires information to exactly match what individuals have entered in the past, if they have already been involved with any Department of Social and Health Services program. The website spits out error codes and halts online applications if, for example, someone once wrote her name "MaryAnne" and now uses "Mary Anne" on the new application. Because Yakima County has a large number of people who have previously received some service from DSHS and are in the system, this error happens often.

For clients who run into error codes, local in-person assisters have switched over to paper applications and sent them in to the state. But those forms have piled up at the Health Care Authority, which didn't anticipate the volume of applications that would need to be entered by hand into the system. All those error codes have to be resolved by a human operator before enrollment can proceed.

And now, local providers estimate that hundreds or thousands of applications from Yakima County have not yet been processed, leaving those individuals uncertain about when they will get health coverage.

"They're at least four weeks behind in entering the paper applications," said Rhonda Hauff, chief operating officer at Yakima Neighborhood Health Services, the lead organization in Yakima County for coordinating enrollment in new health plans. On top of the error codes, most in-person assisters -- the trained staff whose job is to help people sign up -- didn't receive their final credentials until mid-October, so they were only doing paper applications until then anyway.

The paper option is a "Catch-22," said Manning Pellanda, director of the Health Care Authority's division of eligibility policy and service delivery: It provides a short-term workaround when people are blocked online, but then the paper forms take longer to process on the back end.

When the website works, "We were looking at a 45 minute real-time eligibility decision," Pellanda said. "The last thing we want is to go back to the old days where a paper application is submitted and it does not take 45 minutes; it takes 45 days. That's completely unacceptable to us."

Statewide, Washington Healthplanfinder reports that 91,853 newly eligible people have successfully enrolled in expanded Medicaid as of Nov. 28.

Farm Workers' internal records show their clinics had completed 2,985 applications representing 6,255 individuals, including children, as of Nov. 22. Neighborhood Health says it has turned in 287 applications representing nearly 700 people countywide.

"We know what we've done, and we know with our partners that everybody feels like they're finding a lot of people. ... We're all very anxious to see what the real numbers are from the state," Hauff said.

Census data shows many of the counties that have made the least progress in Medicaid enrollment have high rates of poverty and significant populations of people who don't have high school diplomas and whose primary language is not English.

Bracewell has spoken with the Farm Workers clinic in Spokane, where they've enrolled 6,200 people so far, well on target. The difference there, she said, is that it serves a lot more uninsured adults -- not families who are already in the system because they've signed their children up for Apple Health for Kids. Spokane residents also have fewer residency issues -- the system has to verify citizenship because the undocumented are not eligible.

"So it seems like if you have a very straightforward situation, those applications go through. ... The more data elements that the system has to match with other databases, the more likely you are to hit an error code," she said. "Spokane has been able to do basically all of theirs online because they're not hitting error codes at the rate that we seem to be."

The wahealthplanfinder.org site was down for several days last week. Officials say they're working on a fix for the identity-matching issue that's causing so many problems. They say it's easier to make those changes when the site is in maintenance mode.

"Those are the errors that we're dying over because we need those fixed, and we're encouraged that we will have those fixed very, very soon," Pellanda said.

What worries providers here most is how the stalled enrollment process will impact people's access to care if their applications aren't processed by Jan. 1, when new coverage is supposed to start.

Medicaid has a 90-day retroactive "grace period" within which it will extend coverage back for any services an individual required in those three months. And with new applications and eligibility renewals, the system extends coverage back to the first day of the month in which the request was submitted. But retroactive reimbursement doesn't help patients with immediate medical needs like unfilled prescriptions.

An unexpected consequence of the new system is the number of current Medicaid clients who failed to renew their eligibility last month. Under the old system, clients had to submit renewal forms every 12 months to maintain Medicaid benefits; going forward, renewals will be mostly automatic. But this fall, clients had to go through Healthplanfinder to renew for the first time, and error codes prevented many of them from doing so.

Statewide, as of Dec. 3, 23,000 of the people up for renewal in November had dropped their coverage, compared to 8,000 to 10,000 in an average month.

That number is falling daily as more applications are pushed through; it was 18,000 by Dec. 5. And the Health Care Authority is scrambling to coordinate with managed care plans to ensure that people with emergent needs don't experience a gap in coverage.

"It's very important that we maintain continuity of care," state Medicaid director MaryAnne Lindeblad said.

While seeking broad system fixes, they're also working with individual clients and providers to address emergent care needs.

"It's not something that would work en masse, but on a case-by-case basis, gets someone into the system so their eligibility gets renewed," she said.

The state doesn't yet have a date for when it expects the website to be running smoothly, though Lindeblad and Manning say once the identity-match problem is fixed, everything else should get resolved.

For their part, local providers will remain focused on helping as many clients possible to apply.

"We just have to be a little more patient," Hauff said. "We've done a lot of work and helped a lot of people in a fairly short period of time."

--Molly Rosbach can be reached at 509-577-7728 or [email protected].

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