Unsure If You Qualify for Medicaid, Despite What Healthcare.gov Says? Reapply Via the N.C. System

BoyDoctorMy two elementary school-age sons happen to be among the thousands of North Carolinians caught in a gap between Healthcare.gov and the state Medicaid computer system. After navigating the system to iron out this wrinkle, I have some valuable hands-on experience to share here in hopes that it may be of use to others.  

Glitches in the Healthcare.gov web site have threatened to overshadow the fact that this month thousands of North Carolina families became newly insured, covered by plans sold via the site. One of these glitches is the inability of the federal system to pass Medicaid subscriber data through to state systems.

In a statement this week a representative from the NC Department of Health and Human Services said “the interface between the federal government system and our state system is not working properly from the federal government end. So the application information that people have submitted on line at healthcare.gov is not being transferred electronically to the state.”

Complicating the software glitch is that last year North Carolina rejected an expansion of Medicaid that would have opened up the program to 300,000 more residents. The federal software wasn’t equipped to handle applicants in the two-dozen states whose income made them federally, but not state, eligible.

Here’s what happened in our case: When I signed up for an Affordable Care Act insurance plan in October I was thrilled with the coverage I could access but dismayed that the system told me I could not purchase a similar plan for my two children; instead, based on my income and family size, they would be given North Carolina Medicaid. Since I was fairly certain our family did not meet the state income limits for Medicaid, I called the ACA helpline to check my next steps.

The worker told me that if the site said we were Medicaid eligible then we were, and she told us to wait for further contact from our state offices. I called my county Department of Social Services a few times in November and December, and I was told to wait, that they expected to receive the applications from Healthcare.gov soon.

North Carolina was one of 36 states that opted to let its residents use the federally operated Healthcare.gov to purchase health insurance rather than set up its own state marketplace. Nearly all of the states using this interface have reported systemic problems receiving Medicaid application data. North Carolinians have reported a high incidence of the federal site incorrectly deeming an individual or family eligible for Medicaid services.

NC Health and Human Services representatives said this week that of the applications they’ve been transmitted from the federal site, more than 1,000 were evaluated to be ineligible for the state-sponsored health insurance. The state department has no way to send those rejections back to the website, a situation that leaves families like mine unable to purchase insurance. Although DHHS has a plan in place to facilitate two-way communication with the federal marketplace, it won’t be implemented until later this week at the earliest.

Families that were told during their Marketplace application that they were Medicaid eligible who still haven’t received notice of coverage should apply directly via the state’s automated EPASS application system. Even if their application on Healthcare.gov was complete, DHHS says that individuals may not have Medicaid without filling out a separate application.

A formula on the department’s website can help determine eligibility, and officials say the plans may be backdated to Jan. 1 for families who thought they had coverage after completing the application on Healthcare.gov. Anyone who has questions about their Medicaid application or eligibility should call their county Department of Social Services.

Federal officials say they are confident the system should be fully operational soon. Even though I’m frustrated at falling between the cracks, the problems enrolling my kids in Obamacare haven’t lessened my enthusiasm for health care reform. Change can be difficult, and I’m not surprised the roll-out of this new program has come with hiccups.

It’s January! Have you used your new Affordable Care Act insurance? Tweet us and let us know how it went.




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  1. Marc

    Thank you Jennifer for this information. I am in the exact same situation; my wife was approved to buy insurance through the marketplace (with a subsidy that actually makes it affordable), and my son was deemed ‘may be eligible for Medicaid.’ However, I would much rather purchase a policy for him through the marketplace (given that both policies add to be 2/3 of what I’m paying for one garbage-policy now) than be stuck in this Medicaid ‘limbo’ that I don’t have the option to turn down.


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