Illinois deals with Medicaid application backlogs

Vincent Guerrero applied Dec. 10. Donald Weeks, a diabetic who suffered a heart attack a few years back, submitted his application Dec. 23.

Three months later, neither man has gained coverage under Medicaid, the state-federal health insurance program that was expanded Jan. 1 for hundreds of thousands of low-income Illinoisans as part of the Affordable Care Act.

Their applications are among a backlog of more than 200,000, some that date to October. Unprecedented demand for the taxpayer-funded coverage caught the state flat-footed.

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.

"This is the first time I've ever been uninsured, and it's really nerve-racking," said Guerrero, a 26-year-old who lives in the Avondale neighborhood and works part time at a Mariano's grocery store.

Because of his low income, Guerrero, who was previously covered by his mother's employer-based coverage and a short-term, high-deductible plan, doesn't qualify for federal subsidies to buy a private plan. He was counting on Medicaid coverage to kick in three months ago.

But since submitting his application, Guerrero hasn't heard from the state.

"The thing I'm most frustrated with is all the sweet talk about how this was supposed to be so easy. Somebody has to step up and say, 'We messed up,'" he said. "It's inexcusable."

Last year, Illinois added about 800 workers to help process the expected boom of Medicaid applications, but it has had to make additional emergency hires in recent months. About 25,000 applications per week are being processed, up from about 8,000 a week in November.

"We certainly apologize for the delays, and we recognize their need for health coverage," said Jennifer Wagner, an associate director within the Illinois Department of Human Services. "We ask them to continue to be patient to the extent possible. We've got to get through these bumps in the road, and once we do, it's going to be great."

Patience is wearing thin for many consumers, some of whom held off on buying policies because they expected Medicaid coverage would kick in.

Under the health law, Illinois extended coverage to any adult making up to $15,500 a year or a family of four with annual adjusted income of $31,700.

Donald Weeks, 55, is on four medications for diabetes and heart problems that were previously covered by employer-sponsored insurance that he lost in June when he was laid off. The Bristol, Ill., resident, who is interviewing for jobs, applied for Medicaid on Dec. 23, hoping his coverage would begin Jan. 1.

Weeks, who has a hearing problem and does not use a computer, has been relying on his mother to help him navigate the process.

As of last week, Weeks hadn't heard from the state, and when his mother, Josephine Hanlon, calls or logs on to the state website, his status shows as "submitted."

He was supposed to see a physician this week for a checkup because of his heart condition, but because his coverage has not been approved, he had to cancel.

"It's a nightmare," Hanlon said. "You just thank God that nothing severe has happened. With your health, you just can't tell what tomorrow will bring."

Because of the backlog, Wagner said, the state has implemented emergency measures to prioritize applications for certain patients with immediate health needs. But, she said, the state has no way of identifying those people unless they call Human Services representatives or go to a hospital.