The state’s controversial Medicaid eligibility system dropped hundreds of low-income residents from the health insurance program at the start of the year due to “technical issues” with health plan enrollment.
One employee at the state Department of Human Services, who asked not to be identified because the person wasn’t authorized to speak to the media, estimated that “tens of thousands” of people were mistakenly kicked off the system as of Jan. 1, and workers have had to manually reactivate cases.
A DHS spokeswoman acknowledged there was “an enrollment issue” but said that it affected fewer than 1,500 people, including the most vulnerable population enrolled in the public health insurance program.
“We are not aware of the ‘tens of thousands’ estimation. Based on the information I confirmed with (Med-QUEST Division) administrators, the number of individuals affected is fewer than 1,500,” DHS spokeswoman Keopu Reelitz said in an email. “A portion of those affected are aged, blind or disabled. These (1,500) individuals’ Medicaid eligibility remains effective.”
Med-QUEST is Hawaii’s Medicaid program, which provides health insurance to low-income residents.
Reelitz added that anyone affected will not have a break in coverage.
However, the apparent weeklong computer glitch did disrupt coverage for patients, according to community health center executives.
“There were certainly disruptions in care,” said David Derauf, executive director of Kokua Kalihi Valley, a federally qualified health center with more than 10,000 patients annually, adding that some people were unable to refill medications, see specialists or get procedures done at hospitals.
“You don’t get medicines or health care with Medicaid eligibility; you get it with an insurance card or number from one of the plans,” he said. “There definitely are doctors who won’t see patients who are uninsured. This particular group of patients, by virtue of being aged, blind and disabled, are really at significant risk when they lose their insurance.”
In another case, health insurance for a 1-year-old child who came into the Waianae Coast Comprehensive Health Center was terminated as of Dec. 31 for no apparent reason, said Selena Gaui, a manager at the facility.
“They couldn’t give us a reason,” she said. “They said it was a glitch and that they’re working on it.”
The $155 million Kauhale On-Line Eligibility Application system, or KOLEA, launched in October 2013 to meet requirements for a Medicaid eligibility determination system under the federal Affordable Care Act, has been criticized in the past by health centers and DHS workers for frequent malfunctioning. Most recently a state audit blasted KOLEA for failing to meet federal goals of creating a simple, real-time process for enrolling and determining eligibility for coverage.
“There were technical issues with clients’ health plan enrollment,” Reelitz said. “Note that this is different from our KOLEA app that determines Medicaid eligibility and that clients’ Medicaid eligibility were not affected at all. DHS’ Med-QUEST Division continues to actively remedy this situation.”
DHS had fixed the problem Friday for most of those affected and expects the problem to be completely resolved by today, she said. Affected members can call 524-3370 for assistance.
