- Associated Press - Friday, January 31, 2014

COLUMBIA, S.C. (AP) - South Carolina’s Medicaid agency expects to start receiving data it can use to enroll Medicaid-eligible residents who applied for health insurance through the federal online marketplace.

Deputy Director John Supra told The Associated Press an estimated 10,000 South Carolinians will be added to Medicaid rolls when the agency processes the backlogged applications it should start receiving next week. The applications date to Oct. 1, when the problem-riddled federal website went live.

The data transfer problem was an issue for all 36 states using the federal site, regardless of whether they chose to expand Medicaid.

All are in various stages of “massive beta testing” that arguably should have started more than a year ago, said Matt Salo, executive director of the National Association of Medicaid Directors.

“Nationally, all states are in this window now where they’re trying their best to get this done,” he said. “It’s a work in progress. It’s slow going but progress.”

The website was designed to help people buy private insurance under President Barack Obama’s health overhaul. If shoppers qualified for Medicaid, the site was supposed to send their data to the Medicaid agency in their state. But Medicaid directors were notified in mid-September those transfers wouldn’t immediately work as planned.

In the meantime, the federal Center for Medicare and Medicaid Services sent incomplete data files on people deemed eligible online - called “flat files” - intended to give agencies a rough estimate of how many people they may need to enroll. State Medicaid directors, including Tony Keck in South Carolina, said the data was garbled, incomplete and unusable.

Last month, the federal government began sending expanded flat files that states could use to enroll people temporarily, if they applied for a waiver. Anyone later discovered to be incorrectly enrolled could go through an appeals process.

The federal agency confirmed Thursday that only five states opted to use that alternative method: Arkansas, Montana, New Jersey, North Dakota, and Tennessee.

South Carolina chose not to, partly because of the extra work it created, Supra said.

While the waiver allows states to enroll people on a contingency basis, “once we got all the details about the people, we still had to do a regular determination,” he said.

The entire backlog file for South Carolina contains data on more than 20,000 people, but the agency estimates 10,000 will be enrolled, with coverage retroactive to Jan. 1. Based on the agency’s analysis of what it’s received so far, some applications are duplicates and at least several thousand of the applicants already are enrolled in Medicaid, Supra said.

The federal government began sending the complete files to select states last month, but Salo said the rollout did not go smoothly.

Success for states involves a three-step process of being able to receive the information, ensuring it can be read and processed, then gradually increasing the number of accounts to test the bandwidth. States have had problems with various stages, Salo said.

Ultimately, when the backlogs are dealt with, the transfers are supposed to happen automatically as people apply on the federal site. Then that becomes just another source of applications.

In South Carolina, nearly 20 percent now come from the state’s online application that launched Oct. 1. Keck has encouraged people who think they qualify for the government health insurance for the poor and disabled to go directly to the state’s website and apply rather than the federal one.

Federal spokespeople did not answer questions from The AP this week on how many states are receiving complete files, or if any are caught up on their backlog and receiving data in real time. Instead, they provided a general response.

“CMS is transferring accounts to all states that are ready to receive them,” said Aaron Albright with the Centers for Medicare and Medicaid Services. “Some states are still finishing their development and testing and we are working with them to enable transfers as soon as possible. In the meantime, every state not receiving transfers can enroll people through the alternative options CMS has made available.”

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