42,000 HealthCare.gov applications stalled in Virginia Medicaid - WSLS 10 NBC in Roanoke/Lynchburg Va

42,000 HealthCare.gov applications stalled in Virginia Medicaid limbo

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ROANOKE, VA - There is a big backlog in Virginia Medicaid applications being received. We're told more than 40,000 applications have been stalled and delayed in the system. WSLS started asking questions and found there are problems at the local, state and federal level.

"There's a set of applications out there that are waiting for us to work on but we haven't been able to work on those," said Carl Ayers, the Floyd County Department of Social Services (DSS) director and Virginia League of Social Service Executives president.

Ayers oversees staff processing Medicaid applications.

"Making sure our agency is running as smoothly and effectively as possible," said Ayers.

Here's how it is supposed to work: You apply on the federal healthcare.gov website. If it looks like you may qualify for Medicaid your application gets sent to the Virginia Department of Social Services and onto your local office to be evaluated. The system is designed to also work in reverse. When you apply at a local office if you don't qualify for Medicaid your application gets sent to healthcare.gov to see if you qualify for federal subsidies.

"There have been holdups. there are a substantial number of applications that have not been able to flow either way," said Ayers.

The Virginia Department of Social Services tells us about 42,000 applications are currently waiting to be transferred to Virginia for assessment. They have received 951 from the Federally Facilitated Marketplace (FFM).

"It's frustrating because we know the applications are pending and if there is someone waiting on benefits we want to get them through the door so we can get them the medical care that they need. We don't want people waiting because our process is not working," said Ayers.

Adding to the complications, in October Virginia launched a new online system to process applications called the Virginia Automated Case Management System (VACMS). DSS offices across the Commonwealth are using the new software and say there are problems.

"Staff who work in it frequently have either delays or get kicked out and have to sign back in, reload a page, or try to go back and reenter data to get their information in," said Donna Montgomery who oversees training at the Roanoke County DSS and says keeping up with increased Medicaid applications is a challenge. "The new computer system is taking quite a bit more time to get the paper applications input into the computer system."

Ayers says it used to take staff thirty minutes to process an application but now it's taking more than an hour.

"Everybody has shared their frustration with some issues with the system not functioning the way it was supposed to up front," said Ayers.

Virginia DSS says they knew of the problems in October. Some offices are struggling with the new process, technology and policy changes. We're told they've increased training in those offices and have been making improvements every two weeks to the system to fix the bugs.

"It's very important that the system function effectively," said Ayers.

And right now?

"Right now it's had it's growing pains and it still needs substantial amount of work," said Ayers.

WSLS was repeatedly denied a phone interview with the DSS division director Tom Steinhauser and told he was not available. We emailed questions and got replies but when we asked to speak to someone over the phone for clarification we were told: "a phone interview is not an option at this time, only clarifying questions can be asked; but the department does not wish to have any phone conversations that could be interpreted as an interview."  

Ayers and Montgomery say they've been finding workaround to help people navigate the system and find out if they qualify for benefits.

If you applied through healthcare.gov and you think you may qualify for Medicaid and haven't gotten a response we're told you may want to apply through your local DSS office. You can also apply through Virginia's Common Help website.

DSS says the system is working and 48 offices have processed more than 80-percent of applications they've received. However there are about 120 DSS offices in Virginia. 

We contacted the Centers for Medicare and Medicaid Services (CMS), the US federal agency which administers Medicaid and they say "CMS is actively transferring accounts to all states that are ready to receive them. Some states are still finishing their development and testing and we are actively working with them to enable transfers as quickly as possible. In the meantime, every state not receiving transfers can be enrolling people through alternative options CMS has made available."



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