Thousands of South Carolina residents who filed for Medicaid between October and mid-July are still waiting to find out if they qualify for the government's low-income health insurance program.
While most Medicaid applications are typically approved or denied within six days, the state agency responsible for processing the paperwork hasn't been able to keep pace with an influx from HealthCare.gov.
More than 43,000 South Carolina Medicaid applications were submitted through the new federal health insurance marketplace between Oct. 1 and July 13, but the S.C. Department of Health and Human Services has only managed to make its way through 25 percent of them.
Nevertheless, agency officials have promised the federal government that they will finish the rest within 20 working days.
The state recently assigned more employees to the task, implemented new productivity standards and offered volunteers additional hours to make sure that goal is met.
"I think what we know from most other states, they are in very similar positions," said S.C. Medicaid Director Tony Keck.
South Carolina is one of about half of all states that will not expand Medicaid eligibility under the Affordable Care Act.
Still, application volume is running high, in part because of an aggressive federal marketing strategy launched alongside the new insurance marketplace.
The agency continues to process additional applications filed through its own website, by phone or in person.
The application backlog isn't entirely South Carolina's fault and other states are dealing with the same problem, Keck said.
An electronic transfer glitch between the federal marketplace and the state Medicaid agency held thousands of applications in limbo for several months.
Even through mid-July, the state agency had only received 37,815 of the 43,401 Medicaid applications filed through HealthCare.gov since Oct. 1. It has processed 11,191 of them.
"We did have several cases where families had been waiting since the beginning of the year," said Shelli Quenga, programs director for Palmetto Project, a local nonprofit group that assists residents who need help filing Medicaid applications. "Families who are working multiple minimum wage jobs, they don't have time to play phone tag with an eligibility worker to find out what's taking so long."
Of the remaining 26,624 applications South Carolina has received from the federal government, about 11,000 are seeking coverage based on a disability or a request for long-term care - almost twice the normal percentage for similar applications.
"It's very unusual that that large of a number of disability applications would come in," Keck said. He speculated that a question on the application oversimplified the definition of disability and may have confused applicants who don't technically meet the criteria for it.
Those particular applications take longer to process and many of them will likely be denied, he said.
Meanwhile, a number of other states are also struggling to process volumes of Medicaid applications from the federal marketplace that they weren't prepared to handle.
On June 27, the federal Centers for Medicare & Medicaid Services (CMS) sent Alaska, California, Kansas, Michigan, Missouri and Tennessee letters asking those states to address their Medicaid backlog. Last week, three groups filed a class action lawsuit against Tennessee for failing to make Medicaid eligibility determinations within 45 days, The Associated Press reported.
South Carolina has not received a letter from the federal government or been sued for its Medicaid backlog, but the state agency does participate in weekly conference calls to update federal officials on its progress, Keck said.
"CMS has to be significantly concerned to send letters like that," he said. "We've been on regular calls with them. Everybody has the same concerns ... We have a plan in place."
That includes introducing new employee performance standards for the first time earlier this month. The agency's 40 employees who are reviewing federal marketplace applications are expected to complete 900 cases a day.
"There were a number of people, when we applied those standards, (who) weren't working up to the benchmark," Keck said. "Literally within a week, we had a huge turnaround in terms of productivity."
The agency is projected to spend $234,000 to staff the project. Some supervisors who volunteer to work longer days will be paid $23 an hour.
It has also reassigned 10 more employees to the team. There are approximately 55 fewer staff working in Medicaid eligibility than there were in January 2011 when Keck became the agency's director. He introduced Express Lane Eligibility, a program that automatically enrolls thousands of children in Medicaid based on Department of Social Services data. He said the initiative reduced the department's need for people to process applications.
"We took lots of work off their plate. Now there's new work on their plate," he said.
At least, Quenga said, the state has been straightforward about its struggle to process the applications.
"We're in the best of bad company," she said. "It's a very unfortunate situation."
Reach Lauren Sausser at 937-5598.
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