As Medicaid patients wait for coverage, nonprofits fill gap
Posted February 18, 2014
Raleigh, N.C. — As Wake County social services works to catch up on a three- to four-month backlog of Medicaid cases, the agency is also turning to a local nonprofit for help.
The county is paying Urban Ministries $20,000 so it can refer Medicaid patients waiting on prescription coverage to the nonprofit's Filling in the Gaps program. FIGs provides vouchers, which Medicaid clients can use for medication at area pharmacies.
"Patients come to us, we see if they're eligible for the use of our fund and we give them authorizations to fill their prescriptions at pharmacies, who give us really good rates," Urban Ministries Executive Director Peter Morris said.
Wake Assistant Human Services Director Liz Scott said that, because providers have a year to bill Medicaid, doctors are often more willing than pharmacies to serve low-income patients with applications idling in the system.
“Providers will often see someone who has a pending application knowing they’ll be able to bill later," Scott said. "It’s hard to get a pharmacy to fill a prescription.”
Morris said that's a problem for many people on Medicaid, who can't afford to pay out of pocket and often have chronic conditions such as diabetes or high blood pressure.
"It's more likely to see people choosing between food and prescription – do a partial fill of a prescription and take their medication every other day instead of every day or, in some months, not fill the prescription at all," Morris said.
While donation drives at local churches pay for most of the FIGs program's $100,000 annual budget, Scott said the partnership was an attempt to avoid some of the problems the county faced as a massive backlog of food stamp cases built up months after the launch of the state's new NC FAST system in 2013.
“Because of the issues that we have experienced in (Food & Nutrition Services), we wanted to be prepared where, if a case was hung up in the system for some system problem and the person had a severe need for prescriptions, that we would be able to refer them somewhere,” Scott said.
It's a problem patients will have to deal with for a while.
Wake County commissioners approved a $1.7 million plan Monday to expand the number of Division of Social Services employees by 36 positions. They're hoping the extra workers will help compensate for a caseload that has grown by about 45 percent over the last five years in family and children's Medicaid alone.
“We have not really met the targets for Medicaid processing in a year," Scott said, noting that the problems predate both NC FAST and new Affordable Care Act rules. "So, we've been pretty consistently behind.”
But even with the extra staff, officials say they won't be caught up on Medicaid applications and recertifications until Oct. 1.
Morris said that, although the $20,000 from Wake County won't cover everyone, it's a start,
"We'll see how delayed the Medicaid applications can be and see how far we can go," Morris said.