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Published February 10, 2014, 04:55 PM

Medicaid’s expansion for low-income uninsured creates tough transition

GRAND FORKS, N.D. -- With many more North Dakotans eligible for low-income health insurance through Medicaid expansion, Grand Forks County’s office has been flooded with applications.

By: Charly Haley, Grand Forks Herald

GRAND FORKS, N.D. -- With many more North Dakotans eligible for low-income health insurance through Medicaid expansion, Grand Forks County’s office has been flooded with applications.

There were about 300 new Medicaid applications in January, compared to the 100 to 150 in an average month, said Luellen Hart, county Social Services program administrator for economic assistance programs.

“People are really scrambling (to apply),” Hart said. While there’s no deadline on Medicaid applications, the open enrollment period for the Affordable Care Act’s new federal marketplace health insurance ends March 31.

“People are now really in a rush because if they’re not eligible for Medicaid, they’ll be going to the marketplace,” or they’ll have to pay the tax penalty for not having health insurance, Hart said.

And the influx of applications has put county staff in a bind for time and resources.

Medicaid expansion went into effect nationally Jan. 1. North Dakota started accepting applications Oct. 1, said LuWanna Lawrence, spokeswoman for the state Department of Human Services.

North Dakota was one of 25 states that implemented the expansion, according to the Kaiser Family Foundation, which tracks progress of the Affordable Care Act.

Expanded eligibility

For North Dakota, the expansion increased eligibility for people between ages 21 and 65, Hart said. People between those ages were previously only eligible for Medicaid if they were disabled, pregnant or caretakers of deprived children, she said.

“You could have zero income, zero assets and cancer” but still not qualify for Medicaid in that age group, Hart said.

Some of the county’s increase in applications has come from people who previously didn’t qualify, but another part of the increase is likely from people whose employers dropped health insurance as a benefit because of the availability of federal marketplace insurance, Hart said.

And, in addition to the roughly 300 new applicants in January, about 100 pending applications were redone after the expansion, she said.

While the high volume of applications is slowing the process, a new computer system is also time-consuming.

North Dakota is getting a new computer system for processing applications to align with the federal system, Hart said. Right now, Hart’s office is working between the old system and temporary systems until the new computer system is complete.

“We just got moved into this so fast,” Hart said. “Somehow everyone got behind in creating systems.”

The county hired two additional staff members to ease the transition, but Medicaid applications in Grand Forks County are still taking about six weeks to process, Hart said. Before the Medicaid expansion it would normally take two to three weeks, or, depending on the applicant, they could even be processed in the same day, she said.

Grand Forks County isn’t the only area of North Dakota with an increase in Medicaid applications since the expansion. There has been a 49 percent increase in Medicaid applications statewide, Lawrence said in an email.

Typically, counties with larger populations, like Grand Forks County, are receiving more applications than counties with smaller populations, she said.

And even nationally, parts of the Affordable Care Act transition have been rocky, Hart said, referring to the multiple delays in the federal marketplace website, healthcare.gov, as an example.

“From the federal level all the way down, I think it’s just a bigger project than anyone thought it would be,” Hart said.