Expanded Obamacare Medicaid backlog means financial bind – The Star-Ledger

As a nuclear medicine technician who has seen his work hours cut to just eight a week, Dhiru Dhebaria, of Edison, was thrilled to discover he, his wife and his son now qualified for expanded Medicaid.

After answering some extra questions about his wife’s immigration status, all three were approved last fall for NJ FamilyCare, as Medicaid is called in New Jersey.
He and his son got their proof-of-insurance cards. But his wife, Bharatiben, is still waiting for hers.

“I’ve been calling every week for five months,” he said. “I don’t have a clue what to do.”

By all accounts, enrollment in the expanded Medicaid program has gone well in New Jersey. The numbers are robust as the program’s expansion under the Affordable Care Act allows single residents and childless couples to get coverage provided their income is low enough. But getting an actual ID card that allows someone to see a doctor? The flood of applicants appears to have resulted in a systemwide backlog, according to applicants and field workers.

“I’ve heard getting an actual Medicaid card is nearly impossible. It’s like getting Willy Wonka’s Golden Ticket,” said Rena Jordan, director of external affairs for Planned Parenthood of Metropolitan Jersey, which has been helping patients enroll.

“A lot of strange things have been happening, that’s the easiest way to say it,” said Virginia Nelson, administrative supervisor of the Medicaid Department for Middlesex County.

The flood of phone calls to her office about older cases has taken time away from processing the newest cases, Nelson said.

Federal officials conceded some of the blame for the delay can be put squarely at the feet of the federal website, healthcare.gov. That website transferred data about applicants whose income looked like they might qualify for Medicaid to the state system, but in a format the state system couldn’t use.

Since the state received the information about enrollees from the federal website, it has processed about 60,000 of those applications, said Nicole Brossoie, spokeswoman for NJ FamilyCare.

Compounding the problem is some people have submitted duplicate applications, which the agency then has to sort through, according to Brossoie.

The ACA enrollment counselor at Planned Parenthood of Metropolitan New Jersey has helped 230 patients sign up for either private insurance or Medicaid via the federal website, healthcare.gov.

So far not a single one of the Medicaid enrollees has received a card, said Kalimah Johnson. Worse yet, she said she can’t get any answers on their behalf.

“Medicaid is not responding to anyone,” she said. The state’s toll-free number sometimes works and sometimes cuts off callers. Essex County’s phone number for local Medicaid inquiries reaches a recording that its message box is full.

“It disconnects you,” Johnson said. “It doesn’t even work to let you leave a number.” (In response to an inquiry, a spokesman for Essex County said all comments had to come from Brossoie.)

Without a card, patients — even women who are pregnant — can’t see a doctor unless they’re willing to pay out of pocket.

Kim Peterson, 51, of East Orange, has her Medicaid confirmation number, but no card. Inquiries get her nowhere. “I haven’t heard anything from anyone,” she said.
She’s a substitute teacher and part-time college student who wants to keep up on her preventive doctor and dentist visits, but for now, that means finding room in her budget for the $50 office fee. “It’s adding up,” she said.

People in her situation should be able to get care at hospitals or any federally qualified health center, Brossoie said. They will have what’s called “presumptive eligibility,” but will need to fill out an interim application once there.

New Jersey is one of three states that chose to both expand Medicaid and rely on the federal website instead of operating its own. It took months to resolve the technical problem of transferring information between the two programs, said Rachel Klein, enrollment program director of Families America, a non-profit that supports the new law.

Since December, NJ FamilyCare enrollment has grown by about 83,000, for a total of about 1,387,000 residents. Just under half are children.

Unlike Obamacare, there is no enrollment deadline to seek coverage through NJ FamilyCare. People may sign up throughout the year.