Waiting a few weeks to see a doctor can be distressing enough for anyone. But Coloradans in need of Medicaid assistance sometimes wait months just to find out if they are eligible for such care. While they wait (and wait), doctors, clinics and other medical providers often won’t see them.
Federal law requires a prompt determination of eligibility, but some Colorado counties have been unable to keep up with the pace of applications. A bill by state Rep. Al White, R-Winter Park, would reduce the wait time for people who need government assistance – and for the providers of such services. Despite strong opposition from the state Department of Health Care Policy and Financing, we urge lawmakers to pass House Bill 1186.
The department administers Colorado’s Medicaid program, and current law says the agency “may” review an application if a county fails to meet the federal time guidelines for processing. HB 1186 amends the law to make it mandatory that the state review a completed application if the applicant or the prospective provider of Medicaid services requests it.
Medicaid delays can literally affect the most vulnerable people in our state, and the institutions which serve them. Arlene Miles, President and CEO of Colorado Health Care Association, the trade group for nursing homes, says Colorado is currently more than $12 million behind in reimbursing nursing homes for Medicaid services already delivered. Some homes have been forced to take writeoffs.
Federal law requires that applications for Medicaid coverage and annual eligibility reviews be processed in 45 days or 90 days, depending on the type of care needed.
But the processing time is sometimes far longer due to caseload growth and other problems, and there’s no recourse in Colorado if the deadlines are not met.
Dr. John Witwer, director of the Colorado Benefits Management System, the computer program that processes Medicaid applications, says that a fully completed application can be processed in two hours or less. (Problems with the CBMS have contributed to Medicaid processing delays, but some counties are simply overwhelmed by the caseload.)
Hollie Stevenson, spokesperson for the state health agency, says most counties are processing applications on time. Department officials claim the process required by HB 1186 would cost $800,000 a year and require the state to establish a unit to review eligibility. The state’s share would be $387,400; the federal government would pay the rest. But Rep. White believes the actual cost would be much less and has asked for a review of the department’s numbers.
Financially, long-term care facilities suffer the most from the delays because many Medicaid applicants are already nursing-home patients. Some patients are having their annual eligibility re-determined as required by Medicaid. Others are private nursing-home patients who use up their own money and apply for Medicaid.
Lawmakers should pass the bill. The state needs to eliminate the backlog of Medicaid applications so Coloradans will receive timely care and providers can be paid for their services.
