World and Nation

Problems with federal health portal stymie Medicaid

WASHINGTON — Problems with the federal health insurance website have prevented tens of thousands of low-income people from signing up for Medicaid even though they are eligible, federal and state officials say, undermining one of the chief goals of the 2010 health care law.

The website,, is primarily seen as a place to buy private insurance with federal subsidies, but it is also a gateway to Medicaid, which generally provides more benefits at less cost to consumers.

That door has been closed for the last six weeks, with the federal government unable to transfer its files to state Medicaid programs as it is supposed to do.

The delays are affecting people in 36 states that rely on the federal exchange, regardless of whether those states are expanding eligibility for Medicaid as authorized by the health care law. About half of all states have chosen to do so.

Obama administration officials once envisioned a seamless application process in which consumers would use a single form to apply for Medicaid, tax credits and the Children’s Health Insurance Program, and most eligibility decisions would be made instantaneously. Under rules issued last year by Kathleen Sebelius, the secretary of health and human services, an exchange must transfer information to Medicaid “promptly and without undue delay,” using a “secure electronic interface.”

The administration is not meeting its own standards.

Marilyn B. Tavenner, the administrator of the Centers for Medicare and Medicaid Services, who oversaw the creation of the troubled federal website, said she decided in September to delay the Medicaid transfers so technicians could “spend more time concentrating on the application process” and other priorities.

The White House has not released enrollment data, but some states running their own exchanges, like Kentucky, Minnesota and Washington, say more people have signed up for Medicaid than for private insurance.

The Obama administration has adopted what it calls a “no wrong door” policy: If a person files an application with the exchange for private insurance but appears to be eligible for Medicaid, the exchange will automatically transfer the full application to the state Medicaid agency, and vice versa.

“We have not seen much progress on the flow of data from the federal marketplace to the state,” said Monica H. Coury, assistant director of the Medicaid program in Arizona. “After a person is assessed as potentially eligible for Medicaid, the application just sits there in the federal marketplace. If you need insurance because you have a serious medical condition, that delay could be harmful.”

People going to an exchange do not necessarily know if they are eligible for Medicaid or for tax credits to subsidize the purchase of private insurance on the exchange. Sebelius has said repeatedly that “the marketplace will provide consumers and small businesses one-stop shopping for health insurance.”