Texas Health and Human Services Commissioner Kyle Janek raised concerns on Tuesday about a temporary process set up by the Obama administration to help transfer applications for Medicaid from the federal health insurance marketplace over to the state.
“As Jan. 1, 2014, approaches, I remain deeply concerned about issues with healthcare.gov,” Janek wrote in a letter to U.S. Health and Human Services Secretary Kathleen Sebelius. Specifically, Janek’s letter questioned a lack of testing on the temporary process, the accuracy of patient information being sent to the state and how the additional workload on the state health agency would impact other state-run programs.
President Obama’s signature health law, the Affordable Care Act, requires most individuals to carry health insurance by March 31, 2014. Texas’ state leadership, which vehemently opposes the law, declined to set up a state-run health insurance marketplace to help consumers apply for tax credits and find coverage, so the federal government is doing it instead. Although the federal marketplace has experienced a myriad of technical problems, many aspects of the website have improved since its launch on Oct. 1. Still, the website cannot transfer complete applications for individuals deemed eligible for Medicaid or the Children’s Health Insurance Plan (CHIP) to states.
On Nov. 29, Cindy Mann, director of the Centers for Medicare and Medicaid Services, sent a letter to the Texas Health and Human Services Commission outlining a temporary enrollment process for individuals and children deemed eligible for Medicaid or CHIP. The temporary process directs the state to enroll applicants with only preliminary information, such as a date of birth, Social Security number and modified adjusted gross income. If the state ultimately determines that the individual is not eligible for Medicaid, the enrollee would be given advance notice that his or her Medicaid coverage would be canceled and could appeal the state’s decision to terminate coverage.
“As we move forward into 2014, we know that states are working hard to meet many implementation goals and timeframes,” Mann wrote in the letter. “We anticipate that the strategy described in this letter will enable states to ensure that eligible individuals have timely access to Medicaid and CHIP coverage in a simple and streamlined manner.”
In his letter to Sebelius, Janek voiced concerns that the federal government did not do enough testing to ensure the file transfers worked properly — “one-way transfer of data for three cases is not a sufficient test” — and challenged the accuracy of the spreadsheets containing information on applicants the federal website had deemed eligible for Medicaid or CHIP.
“Our review of the spreadsheets for Texas found individuals with addresses from other states — including as far away as New York, fields that were left blank and people who are already receiving Medicaid or CHIP,” wrote Janek. Although HHSC has been instructed to enroll these individuals in Texas Medicaid, as the federal government has notified them that they will begin receiving coverage on Jan. 1, Janek said the state has no way to validate that those individuals meet the state’s eligibility requirements.
“We need to know how you will correct any errors that the state may find in the federal determinations and how you will communicate those mistakes to the affected individuals,” Janek said. He also asked for “full federal funding to cover the cost of any workload impacts on our eligibility staff arising from problems with the federal rollout, particularly for additional time required to resolve eligibility issues related to incorrect referrals to our system.”
Currently, Texas has an integrated eligibility system for the Medicaid, Temporary Assistance for Needy Families and Supplemental Nutrition Assistance programs. Texas is already working to make changes to the state’s eligibility process to comply with the Affordable Care Act.
“As your vendors and staff work to repair healthcare.gov, they risk making changes that have cascading impacts throughout the state system,” Janek said. For example, he said a recent federal change prompted a state process that checks to see if an applicant already has information in the Texas system to stop working.
This story was produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.