Medicaid expansion remains a topic of heated debate. So do numerous other aspects of the Patient Protection and Affordable Care Act.

But there should be no debate about the need to give Americans who apply for Medicaid fair - and prompt - notification of whether they are eligible for the program.

Unfortunately, though, as reported on Tuesday's front page by Lauren Sausser, that need is not being met in our state.

The story began: "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"

That's despite the fact that South Carolina is one of the two dozen states that have not agreed to participate in the Affordable Care Act's expansion of Medicaid eligibility up to 138 percent of the federal poverty income level.

S.C. Department of Health and Human Services director Tony Keck has responded to the Medicaid-application backlog by putting more employees on the job of reducing it and implementing new "productivity standards."

The difficulty of the task has been intensified by a technical glitch in electronic transfers between the federal system and the state Medicaid agency.

While it's of no consolation to the thousands of South Carolinians waiting to learn where they stand with Medicaid, our state evidently isn't as far behind on this obligation as some others.

Late last month, the federal Center for Medicare & Medicaid Services (CMS) sent letters to officials in Alaska, California, Kansas, Michigan, Missouri and Tennessee asking them to address their Medicaid backlogs. Tennessee is also the target of a class-action lawsuit by three groups for its delays in determining Medicaid eligibility.

South Carolina hasn't received any such letters from the CMS, or any notifications of legal action.


Mr. Keck told our reporter: "CMS has to be significantly concerned to send letters like that. We've been on regular calls with them. Everybody has the same concerns."

So the folks in charge at both the state and federal levels must resolve those concerns.

As for the Medicaid expansion debate, it stemmed from the 2012 Supreme Court decision upholding Obamacare.

Though the justices, by a 5-4 margin, ruled the landmark law constitutional, they struck down its requirement for states to raise the eligibility income for Medicaid. That allowed South Carolina - as in Gov. Nikki Haley and the General Assembly - to opt out of the change.

Those pushing expansion insist that it would be "free" for the state. The Affordable Care Act stipulates that its costs are 100 percent covered by Washington through 2017. Then the states are scheduled to start paying low but rising percentages of expansion costs, capping at 10 percent in 2020.

So why aren't all states taking that deal?

Because expensive experience teaches that it's reasonable to be wary of federal promises about health care costs.

And Medicaid has already consumed increasing shares of the budgets of most states, including South Carolina, over the past few decades.

Still, Americans on both sides of the Obamacare expansion argument should agree that the lengthy delay in the processing of so many Medicaid applications is unhealthy - and unacceptable.

Mr. Keck told our reporter that there "is a plan in place" to fix this mess.

The sooner, the better.