short circuit, burnt cable

The uninsured percentage of the US population is at an all-time low of 13.4 percent from the 18 percent before the Affordable Care Act was rolled out. Approximately 15 million people who did not have health coverage before Obamacare enrolled in a health insurance plan under this new law without any discrimination on the basis of pre-existing medical conditions. The ACA also served as a catalyst for 6 million people who were deemed eligible for expanded Medicaid coverage. The newly eligible applied for Medicaid, but were left in a lurch when their applications went into a pending status. Nearly 1.7 million applications are in backlog, and people are waiting to get through the system.

As the second enrollment period nears, the Medicaid department is already stretched thin for resources, and they will soon have work around eligibility determinations, complicated application hurdles and drying up state funds in a smaller time window. However, the administration is trying to best these challenges. Here are some strategies the Medicaid directors are putting together to sail through these troubled waters.

1)  Setting Up Dedicated Centers for Customer Help – The first enrollment period saw customers flocking to navigators and exchange authorities for help. People consulted the official healthcare.gov centers for all questions and troubles they were facing while enrolling. A similar trend manifested for Medicaid, people were quick to call to check on applications and inquire on the status. In the second enrollment, Medicaid coverage will reach out to people who did not get covered in the first period, and that means more questions and more queries that are community specific. Since there will be no additional resources, the call volume per navigator will be high, and the navigators need to be ready. Further, since special communities will be the central theme this year, navigators with any other primary language than English will be preferred. In-depth training for these navigators are already underway and will help educate representatives on the most commonly asked questions and the  typical challenges their callers might face in the second enrollment period.

2)  Dedicated Backlog Management – Other than gearing up for new applications, a dedicated backlog management process is in the works for handling the Medicaid applications currently stuck in the system. Most of these applications are the ones which require eligibility redetermination; and that requires a complete pacing of the app through the system. In order to clear these backlogs, an escalation system is being created that will separate complex applications from the simpler ones and allow those to go through smoothly. This escalation system will weigh the application on the basis of complexity and decide whether to pass it through or take it to the next level.

3)  New Application Handling – With the above escalation system, the administration plans to speed up new application handling. Other than the escalation system, the newer applications will also go through a decentralized enrollment system. The decentralized enrollment system will rely on district and county offices to process eligibility. For counties and districts where the pressure of applications is too much, a central system will be established that will help ease off the load. A review of the implemented improvements will ease out bottlenecks and control the risks of the system.

Due to mounting pressure and only a short time left before the second enrollment, the administration will have to implement these strategies as soon as possible. While contact centers are already making progress on trainings and implementation, backlog clearance and new application handling are far from satisfactory. If the administration is unable to streamline these issues before November 15th, the going will be smooth, else the Medicaid enrollments could turn out to be a bigger challenge than the government had expected.

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