Eric Harkle Road / KHN (Image / Getty Images / Splash Release)
Eric Harkle Road / KHN (Image / Getty Images / Splash Release)
In October, after Missouri expanded Medicaid in 2021, she took out health insurance when Jamie Taylor’s monthly household income fell within the new state’s income limits. She received a letter of refusal within a few days, stating that her income was out of tolerance.
It was the latest blow to Taylor’s ongoing campaign to get help from the Missouri Safety Net. 41-year-old Taylor spends hours on the phone, enduring four hours of hold time and disconnection. Time-sensitive documents were mailed to her home in Cycleston, but she had little time to act by the time they arrived.
Her recent refusal-she will know later-due to a pre-programmed glitch in her application where the technician enrolling her wasn’t caught.
Taylor’s struggle for her actual qualified benefits is not uncommon in Missouri and across the country. They derive from the very outdated technology used by the huge web of government agencies, from local public health to state-owned benefit programs. Matt Salo, Managing Director of the National Association of State Medicaid Directors, calls the need for technology upgrades “the next big challenge the government has to solve.”
The COVID crisis has revealed how many outdated and unequipped systems are available to handle unprecedented demand. Private companies have enhanced the streaming capabilities of TV shows, created apps for food delivery, and moved offices online, but some public health authorities tracked COVID outbreaks on fax machines.
Jamie Taylor dealt with a four-hour hold and hung up while trying to secure the public interest in Missouri. Others have encountered similar problems across the country as the pandemic has highlighted the pitfalls of outdated government technology.
Krissy Pruiett
Hide captions
Switch captions
Krissy Pruiett
Jamie Taylor dealt with a four-hour hold and hung up while trying to secure the public interest in Missouri. Others have encountered similar problems across the country as the pandemic has highlighted the pitfalls of outdated government technology.
Krissy Pruiett
However, momentum is finally gaining momentum towards government technology updates. With a once-in-a-generation pool of funds available from pandemic bailout funds and higher-than-expected tax revenues, some efforts are underway. President Joe Biden issued a presidential directive in December calling for rationalization of benefits registration. State legislators are encouraging the use of unused COVID bailouts to address this issue.
According to Jessica Khan, a partner at McKinsey & Company’s consulting firm and former leader of Medicaid’s data and systems at the Medicaid & Medicaid Service Center, outdated information systems have a spillover effect on the entire public interest system. This is important because it can cause it. One example: An online benefits application that is difficult to navigate can force more applicants to call the phone helpline. This, like many industries, can strain call centers where staffing needs are difficult to meet.
Some states are already looking to improve:
In Wisconsin, Democratic Governor Tony Evers has ordered up to $ 80 million to replace the state’s old unemployment infrastructure.
Kansas is one of the first states to work with the newly established Unemployment Insurance Modernization Department of the US Department of Labor, which was set up to manage the $ 2 billion of funds allocated by the US Rescue Planning Act last year.
In Missouri, a bipartisan State Senate has recommended that the Social Welfare Department use the surplus COVID Relief Fund to update the benefit computer system. The ministry also proposes to use federal pandemic funds for artificial intelligence to process about 50,000 documents a week. That work is currently done manually in an average of 2 minutes per document.
Lack of funding is nothing new to public health and safety net programs. Civil servants are reluctant to allocate the necessary funds to overhaul an outdated computer system (a project that can cost tens of millions of dollars). But even when money is there, recent history suggests that it may be easier to say than these improvements are made.
More than a decade ago, the Obama administration invested $ 36 billion to develop and mandate the nationwide use of patient electronic health records. Despite billions of dollars invested, digitizing patient records has been plagued by problems. Indeed, patients must fax or mail claims and receipts in order for the insurer to benefit from the new Biden administration’s requirement to refund the insurer for prompt inspection.
The Affordable Care Act also provided an opportunity to improve the state’s technological infrastructure. From 2011 to 2018, the federal government proposed to cover up to 90% of the funding needed to replace or renew an old Medicaid IT system. Many were programmed in COBOL, a computer programming language dating back to 1959. State-managed support programs frequently share technology and personnel, as do some of the government’s safety nets.
However, according to Salo, the ACA has required these new Medicaid computer systems to communicate directly with legally created medical institutions. The state faced various degrees of problems. The Tennessee application was lost, leading to a class action proceeding. In many states, the benefit system has never been completely reviewed.
During the pandemic, technical issues can no longer be ignored. Hundreds of thousands of people have been waiting for months to help unemployment as states such as New Jersey, Kansas, and Wisconsin struggled to program newly created benefits into existing software during the initial blockade. rice field. Local and state vaccine registration sites were plagued by many issues that were inaccessible to many, including the visually impaired and federal disability law violations.
In Missouri, where Jamie Taylor lives, the state’s Medicaid Program’s 2019 McKinsey evaluation shows that the system consists of approximately 70 components that have been partially developed within the mainframe since 1979. It is not arranged to meet both needs. ”
In the State Department’s 2020 report, Social Welfare Department staff called the benefits registration process “silos” and “built on workarounds,” and participants called it “dehumanization.” I called.
Taylor experienced it first hand. Eight years ago, due to a mysterious medical condition, she lost her workforce and lost her work-based health insurance. At various times, she was diagnosed with ulcerative colitis, Crohn’s disease, gastritis, inflammatory bowel disease, and gastroparesis, but she was not covered by insurance and was not eligible for Medicade, so she was treated in an emergency room. I was forced to do so. She has been hospitalized repeatedly for many years. She estimated her medical debt to exceed $ 100,000.
At the request of a hospital social worker, Taylor applied for Medicaid, a federal public health insurance program for low-income earners, six times from 2019, but it was not one of the state’s minimum income requirements. .. A nation before voters approve the expansion of the program. Her first two refusal letters began with “Good News.”
The October refusal was the most traumatic because she knew she would qualify under the new state guidelines.
At a loss, Taylor reached out to Congressman Sarah Unsicker. Democrats represent St. Louis’ 145-mile-away district, but Taylor saw on Twitter the expansion of her advocacy Medicaid. After Unsicker contacted the department, she learned that the default answer for her application that the technician who registered her missed was Taylor’s disqualification to get Medicaid. .. It mistakenly listed her as receiving Medicare — public insurance designed for older Americans who are not qualified by Taylor.
“Within 24 hours, I received a message from Sarah that another letter had arrived. I should be more happy with the answer,” Taylor recalls.
Finally registered with Medicaid, Taylor is currently struggling to get nutritional support called SNAP, which is processed by another qualification system in Missouri. According to a 2019 analysis by the Code for America Advocacy Group, Medicaid and SNAP applications are combined in 31 states. But it’s not hers. The program has similar income requirements, but Taylor couldn’t confirm his income over the phone with SNAP, unlike with Medicaid.
Instead, she received a letter on November 26, requesting a tax return by November 29. By the time she was able to find and email those documents on December 1, she had been rejected. She said that all the calls to solve the problem would fill up the hold time or queue for more than 4 hours and hang up.
“It doesn’t make sense to me why Medicaid can check my tax revenue over the phone, but SNAP has to send me all copies,” says Taylor.
Eventually, she gave up and started the whole process over. She is still waiting
KHN (Kaiser Health News) is a national news room that produces detailed journalism on health issues. KHN is an editorial independent operation program. KFF (Kaiser Family Foundation). KFF is a donated non-profit organization that provides the public with information on health issues.
