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Technical glitch bungles Medicaid enrollment for 25,000 Pennsylvania residents

| Tuesday, Dec. 31, 2013, 10:18 p.m.

The day before health insurance was set to kick in for millions of Americans under Obamacare, a new problem emerged on Tuesday that could leave thousands of Pennsylvanians without the government coverage they thought they had obtained through the troubled federal marketplace.

A technical glitch has prevented states from finalizing Medicaid coverage for some people who applied for insurance on the website that the federal government is operating for Pennsylvania and 35 other states, officials disclosed.

It is unclear how many people nationwide might be affected, but Gov. Tom Corbett's office put out a consumer alert that said at least 25,000 low-income Pennsylvanians who received confirmation on the website that they may be eligible for Medicaid or Children's Health Insurance Program coverage “may find out they were not enrolled as anticipated as of Jan. 1.”

The governor's office said residents could not be enrolled in the state health insurance programs because “states received incomplete records from the federal government.”

The problem is just the latest in a series of glitches since the website, HealthCare.gov, started on Oct. 1. Insurers had complained that they were having problems completing enrollments because they were getting garbled or incomplete electronic files from the government.

Julie Bataille, a spokeswoman for the Centers for Medicare & Medicaid Services, which is in charge of HealthCare.gov, said the agency is continuing to work with state Medicaid programs “to ensure that our respective systems can talk to each other.”

But, she told reporters on a conference call, applicants on the website are “given an eligibility determination. .. They must complete their enrollment with each state” to qualify for Medicaid.

Leesa Allen, the state's executive Medicaid director, said that given the problems with the federal website, it would be faster for eligible Medicaid recipients to enroll directly with the state. But, she said, “the whole purpose of the file transfer was so that the recipient wouldn't have to do anything further.”

People who thought they were enrolled in Medicaid or CHIP and discover they are not will have their coverage retroactively started on Jan. 1, said Kait Gillis, spokeswoman for the state Department of Public Welfare.

While 25,000 people who were eligible for Medicaid learned they could enroll in the program through HealthCare.gov, an estimated 500,000 still are waiting to find out whether they'll gain insurance through an alternative Medicaid expansion. Corbett has proposed buying private insurance for Pennsylvanians who fall into a gap in which they make too much money to qualify for Medicaid but not enough to receive federal tax credits through HealthCare.gov.

Corbett would use federal Medicaid funds under his proposal, which is under consideration by the Department of Health and Human Services, and would not start until 2015.

Meanwhile, earlier problems with data transfers between the website and private insurers mostly have been fixed, Bataille said. “All the issuers have all the data for all the people who have selected plans on HealthCare.gov,” she said.

Bill Modoono, a spokesman with UPMC Health Plan, said the insurer is “only seeing very minor problems” with some of the transfers.

Federal officials also said Tuesday that about 2.1 million people will have medical coverage on Wednesday through the Affordable Care Act, after a late surge in enrollment helped regain ground lost to the botched debut of the insurance website.

More than 1.6 million Americans signed up through state and federal exchanges in December alone, according to calculations from data released during the conference call. The December tally is more than quadruple the first two months of the government's sign-up period.

The December surge provided a boost to President Obama, whose fumbling of the October rollout of the insurance exchanges initially thwarted the high participation needed to spread the costs of his health care expansion. The law is supposed to offer private coverage to as many as 7 million people by the end of March.

Critics contended that even with increased sign-ups in December, fewer Americans are insured overall as an estimated 4 million people had their existing health plans canceled because they did not meet more rigorous standards of Obamacare.

In Pennsylvania, for example, about 250,000 people received cancellation notices this fall. Many of them may have taken an option to renew their plans for another year.

Highmark Inc., the state's largest health insurer, has said it sent notices to 140,000 individual customers with an option to renew, and many did so. Another 40,000 members with canceled plans were auto-enrolled in a new plan by Highmark last week if they had not chosen a plan.

“Our belief is that most people who have gotten cancellation notices have already enrolled in a new plan or renewed their old plan,” Bataille said.

Bloomberg news service contributed to this report. Alex Nixon is a staff writer forTrib Total Media. He can be reached at 412-320-7928 or anixon@tribweb.com.

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