Health & Fitness

January 16, 2014

Enrollment issues leaving Texas children uninsured

Thousands of children who are eligible for Medicaid coverage have been unable to enroll in Texas because the state and federal governments weren’t sharing information in the new U.S. healthcare exchange.

Thousands of children who are eligible for Medicaid coverage under the Children’s Health Insurance Program have been unable to enroll in Texas because of a problem between the state and federal governments in sharing files from the federal healthcare exchange.

State officials say they have not received financial information to match the names and addresses of families that have used the website to buy health insurance and have children who qualify for Medicaid. The federal government is supposed to supply the information, state officials said.

A federal official says the government is working closely with states on a function that allows for the automatic transfer of files, but Texas hasn’t taken part.

The result: Some Texans who bought insurance and believed that their children would be covered by Medicaid are being told that the state has no record that their children are enrolled.

State officials say they hope to begin testing the file-transfer function with the federal government on Friday.

“We know there are people out there who are told on the marketplace, ‘Your children are eligible for Medicaid,’ but we don’t have enough information to enroll them,” said Stephanie Goodman, spokeswoman for the Texas Department of State Health Services.

Goodman said that she did not know exactly how many children have not been enrolled but that the state has 65,000 files to review to determine Medicaid eligibility.

Kip Woodruff, a health plan broker in North Richland Hills, said he has been trying to help a client dealing with the issue.

The client, a 55-year-old Fort Worth single mother, received a subsidy for health insurance through the federal exchange and learned that her teenage daughter had defaulted to Medicaid. The girl is diabetic and needs insulin.

But when the mother called Medicaid to verify enrollment, the state office said it had no record of her daughter, Woodruff said.

“I don’t know what she’s going to do at this point,” Woodruff said.

The issue is setting off another political firestorm among state lawmakers, who are strongly divided over the Affordable Care Act.

Advocates for the federal law known as Obamacare say the data-sharing snafu could have been avoided if Texas had opted to create its own healthcare exchange.

“Gov. [Rick] Perry and the Republican Legislature decided that they had no interest in setting up an exchange, which is why now we have two agencies, state and federal, who have got to work together to communicate information better,” said state Rep. Chris Turner, D-Arlington.

But a spokeswoman for Perry said the data-sharing problem is another example of how the system has failed. Besides problems with the file-transfer function, there have been instances when the federal government sent test files with inaccurate information, state officials said.

“The Obama administration is still unable to communicate Medicaid information back to the states,” Perry spokeswoman Lucy Nashed said.

The data-sharing issue prompted the state’s top health commissioner, Dr. Kyle L. Janek, to fire off a letter last month to U.S. Health and Human Services Secretary Kathleen Sebelius.

“We need to know how you will correct any errors that the state may find in the federal determinations and how you will communicate those mistakes to the affected individuals,” Janek wrote Dec. 3.

In the letter, Janek also urged Sebelius to provide funding to support additional manpower to handle incorrect referrals to the state.

Goodman said state workers hope to begin verifying information sent through the file-transferring program Friday.

“But that date has moved many times because of continued federal issues with the system,” she said.

Goodman recommended that all families affected by the problem file a new CHIP application with the state.

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