Last week, federal health officials celebrated two milestones related to the Affordable Care Act. The first, which got considerable attention, was that more than 7 million people selected private health plans in state and federal health insurance exchanges. The second, which got less attention, was that some 3 million additional enrollees had signed up for Medicaid and the Children's Health Insurance Program (public health insurance programs for the poor), many as a result of Medicaid's expansion.
But there are growing signs that Obamacare's Medicaid expansion is a victim of its own success, unable to keep up with demand. While about half the states have refused to expand their Medicaid programs' eligibility, among those that have, some can't process applications fast enough.
Media reports from New Jersey, Illinois and California (states that have expanded their Medicaid programs) show that hundreds of thousands of consumers who may qualify for new Medicaid coverage aren't getting it.
So what's happening?
In Illinois, the Chicago Tribune reported last month that there's a backlog of more than 200,000 applications waiting to be processed.
Illinois officials initially expected 200,000 people to sign up for Medicaid under the expansion in 2014. But through last week, more than double that number have applied. And amid a marketing blitz, officials expect a surge of additional applications by the end of the year.
Unlike new commercial insurance products, which consumers can purchase through March 31, there's no deadline to sign up for Medicaid. By the end of the year, state officials expect about 350,000 new users to be enrolled in the program.
The growing backlog is causing concern among health care providers worried about getting paid, and confusion, frustration and anger among consumers, whose coverage was supposed to begin in January.
Much the same thing is happening in New Jersey, the Star-Ledger reported last week.
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.
And in California, the backlog now numbers 800,000 for Medi-Cal, the state's Medicaid program, the Los Angeles Times reported this week.
One patient wrote The Times to say she has a worrisome growth behind an ovary. She submitted an application in October. County health clinics informed her she won't be able to keep her appointments for blood tests and ultrasound scans until her Medi-Cal coverage is confirmed, she said. Or she can pay full price for the services.
As of Thursday, she was still waiting.
"A lot of good, smart people with good intentions in the state and county are working really hard to fix these problems," said Katie Murphy, managing attorney at Neighborhood Legal Services of Los Angeles County, which has a grant from the state to provide legal assistance to patients with Obamacare enrollment cases. "But until they do, people will fall through the cracks."
A state spokesman told the paper that "the volume of Medi-Cal applications, combined with challenges of new computer systems, hampered the state's ability to complete eligibility reviews in a timely and accurate manner."
Matt Salo, executive director of the National Association of Medicaid Directors, said many of the problems relate to the way HealthCare.gov transfers information to states about consumers who appear to qualify for Medicaid based on their incomes. But there are state-specific issues, as well.
"It's been the number one issue of concern for our members for the past nine months or so," he said in an email. "The problems are getting fixed, but what worries people is that we're only a few months away from NEXT year's open enrollment, so we have to hurry."