State scrambling on Medicaid rules

Under the Affordable Care Act, all states were required to recertify all Medicaid recipients and applicants under new income guidelines as of Jan. 1. North Carolina already received one three-month extension, making the state's new deadline April 1. 

The new guidelines, called Modified Adjustable Gross Income, or MAGI, will exempt certain types of income from eligibility calculations. Veterans' benefits, child support, workers compensation and children's income are currently counted as cash income, but they won't be counted under MAGI. The net effect will be to make more people eligible for Medicaid.

The problem for North Carolina is that, to comply, county workers would have to use NC FAST to verify eligibility under the MAGI rules. That would mean re-entering every existing Medicaid client's case information into the trouble-prone new system over the next three weeks. 

Under the implementation schedule, counties were to begin using NC FAST for Medicaid applications last fall. But significant problems with the system have delayed that phase of implementation. 

Acting state Medicaid director Sandy Terrell said requiring county workers to manually enter all existing Medicaid cases - about 1.8 million of them - into the new system by April 1 would create significant workload problems and could jeopardize continuity of benefits for those recipients. 

Many of those same county workers are already struggling to work through food stamp backlogs in NC FAST to meet a March 31 deadline set by the U.S. Department of Agriculture.

Terrell said the state is asking the federal government to allow it to recertify cases under current state rules in its old Medicaid system, EIS, where those case files already exist. That would allow the process to move much more quickly.

If an applicant or current client is found to be ineligible under state rules, which are more stringent than federal guidelines, his or her case would then be entered into NC FAST to check eligibility under the MAGI rules. 

Terrell said the waiver would not cost the state any money and will "ease administrative burdens because [DSS workers] would be able to use the old system they’re most familiar with." 

In the meantime, Terrell said, DHHS will continue to test NC FAST for Medicaid applications in pilot counties.  

The waiver would have to be approved by the Centers for Medicare & Medicaid Services, a process that can take weeks or months. But Terrell said CMS has approved a similar waiver for another state.