Since the first of the year, Medicaid continues to make changes, good and bad. We can only speak from the pregnancy and newborn side of the application process.

  In dealing with newborns, we are seeing a quicker response to adding newborns born to active Medicaid mothers. This was a positive change from meeting with the VCAN members and a separate queue being formed. The VCAN has requested that Babygrams be sent to the designated queue without a cover sheet due to the time it takes for documentation staff to sort thru the paperwork. However, if there is a newborn born to a mother with private insurance, such as a dependant of a parent’s insurance or to a mother without insurance, the process remains slow and laborious. The recurring theme is paper work is not filed, nor is it able to be located once faxed, and we try to avoid calling the call center due to time holding or trying to figure out what area is most appropriate. The personal contact is not there. We have several cases where the family has applied for Medicaid only to have that application denied due to “failure to produce documents” however they have proof they went to the local help center and faxed the information. So, the whole process has to start again even though we have been told once a document is scanned into the system it remains. So, we are at a loss as to why numerous documents continue to be required with each referral. Example: an original birth certificate from the health department is required for proof of citizenship. On the FSSA document sheet, a hospital birth certificate is listed as an approved document piece, however, this is not acceptable. The issue of a health department issued birth certificate is a real issue for some families due to cost and possibly being born out of state. We are looking at ways to assist our families with this issue. Plus, it would be beneficial to know if documents are kept on file and if so, why is there an issue with some applications.

  The online application process is shorter in length, but the documents are the issue. We can complete an application, have the patient sign, copy their ID and other documents they might have on their person, but once they leave, we have no control as to whether or not they comply with sending in additional information. After so many days, that application is denied and it has to be started again from scratch.  This is frustrating.

The portals that agencies can access through agreements with the VCAN are helpful; however, those too require this release or that piece of paper. Often times we have faxed releases, made an inquiry, only to be told nothing is on file. We then have to refax the paper. Even when we can produce dates when papers are faxed, it does not matter. If it is not scanned into their system, there is no record. There is a lot of time spent faxing and inquiring and this takes staff time, so just think of the time an individual would have to spend tracking things down. It was so much easier for families to have a face to face contact. The help centers are not much help, from what our families are telling us. Even when they go there and file and fax, they still have to produce additional information, have a phone interview or go back to the local office for an interview. This is not consumer friendly process. The portal reports are interesting too. There have been incidents where a standard response has been used on several cases which indicate to us, the inquirer, that cases are not being looked at correctly. Example: For 8 different cases, all cases typed with a name, DOB, last 4 digits of Social Security number, and a brief description as to what was being asked for those cases, the response from the Medicaid reviewer was “there is no release available for Ms. Mendez so your request can not be fulfilled at this time.” Those 8 requests were not all named Ms. Mendez although the correct name was clearly typed above the typed response from the document center.

  The process continues to be cumbersome and unfriendly. Timeliness is still a huge factor. Many girls will deliver before their Medicaid is actually approved. We have seen an increase in self pay pregnant females coming into the hospital lately and many of them do not come with their birth certificate, Social Security cards, pay records, utility expenses, rental cost, spouse’s income records, let alone other members in the household information. Many also do not have transportation to come out here and return information, so the application gets denied for failure to produce information. At this time, we have on record 21 newborns listed as self pay for one reason or another and an additional 41 newborns waiting to have a number assigned. That is a total of 62 newborns waiting since March. Broken into months:

• March              2 self pays remain
• April                4 self pays remain
• May                 11 self pays remain and 21 newborns remain for a total of 32
• June                 4 self pays remain and 35 newborns remain for a total of  39

  Adult cases (65) currently awaiting approval and Social Work is actively following can be broken into the following categories:

• Office Referrals                                  19 cases from TSP, Morrison, Sandefur
• Awaiting State Authorization               4 cases
• Awaiting Additional Information          7 cases and this is additional information needed from the                                                               client
• Signed Consents for Case Releases     26 cases from TWH, TSP, Morrison
• No current Application on File             5 cases from TWH, TSP. These are the ones we make calls                                                               and follow up contact with as much as possible
• Denials received                                  4 cases

Each of the above cases can be broken down into how many times we, Social Work, have made inquiries, sent documents etc. As March 2009, TWH has completed 17 new mom applications from start to finish and still await some approvals or denials to be announced.

  Not certain what changes can be made at this point in the process. Will the Presumptively Eligibility Process help? It will for the initial visits, but if a family or individual does not follow up and produce documentation, Medicaid will not be approved. Plus, the process of producing all the required documentation is not going to go away. Pregnancy and birth of a child is very easy to prove and it should not be so difficult to obtain benefits for either. Pregnant females and newborns are not receiving treatment as recommended due to the hoops one must go thru to receive medical coverage. Some thing needs to change.