Medicaid backlog leaves some without insurance

Jun 13, 2018

Holly Torres and her son Zachary Torres.
Credit Holly Torres

The Alaska Department of Health and Social Services is swamped with applications for programs such as Medicaid, food stamps and temporary assistance for families. But the backlog of applications for Medicaid is certainly the largest, and it’s hitting Alaskans with disabilities hard. Patients are often left without insurance and go weeks or even months just trying to get someone from the department on the phone.

It’s a Sunday morning and Holly Torres and her 10-year-old son Zachary have no plans today but to hang out. Zachary has Down syndrome and his mom said he looks forward to their time together all week.  

“You like the days that we stay home together?” Torres asked her son.

“Yes,” he said.

“We have fun, huh?” she said.

Torres is a single mom and she works full time as South Peninsula Hospital’s CFO. She moved to Alaska with her son from Arizona over a year ago. Since then she’s spent her time making calls and filling out paperwork in hopes of securing Medicaid services for Zachary.

Torres said it took six months for her application to initially get approved.

“It was just a really long time, and I thought it would be two months tops because I'm thinking he has Down syndrome. How much do they really have to evaluate that?”  she said. “I mean he should automatically qualify.”

States are federally required to process Medicaid applications for those with disabilities within three months. Because of Alaska’s backlog, Torres paid for her son’s medical expenses out of pocket while she waited to be approved. Medicaid did eventually reimburse her for those costs, but then Torres lost coverage again.

“I got a call in April when he had an appointment at Providence for his cystic fibrosis, and they told me it's showing that it's denied until I could get it reinstated,” she said. “It took me two or three weeks to finally get ahold of somebody." 

Torres said the state told her it didn’t receive a portion of her paperwork.

Torres re-submitted her paperwork, but in the meantime she’s once again paying out of pocket for Zachary’s medication, which can run between $2,000 and $3,000 per month. She’s also cutting back on the services she can’t afford.

“He was getting occupational therapy. He hasn't gotten that," she said. "He hasn't gone back up to Providence for his cystic fibrosis visits because I would have to take time off from work to take him up there, but Medicaid luckily paid for his flight up there. Even if I submit my receipts, I don't trust that I'll get my money back.”

She’s not the only one struggling with receiving Medicaid benefits. Kate Burkhart is the state’s Ombudsman, which investigates complaints against the state government and agencies.

“We received over 400 complaints related to these issues in the course of two years and many of them were, ‘I applied for benefits for food stamps or for Medicaid, and it's been several months and I haven't heard anything,” Burkhart said of the complaints.

The Ombudsman reported the findings of its investigation last month.

It found that the state Division of Public Assistance, which directly oversees Medicaid in Alaska, is woefully understaffed. Caseloads also increased by about 25 percent since the Affordable Care Act paved the way for Medicaid expansion in 2015.

“The backlog at its height had been about 30,000 cases awaiting attention from the division in June of 2017, which is during the time that we were receiving these complaints,” she said. “They had worked it down to 17,000 cases, still awaiting attention in December of 2017.”

A common complaint came from people receiving Medicaid to pay for long-term care. Bruce Hamilton's mother received long-term care at South Peninsula Hospital in Homer before she passed away. 

He said for years he never had a problem renewing Medicaid for his mother. Then in 2017, he got a notice that a life insurance payout disqualified her for Medicaid. He said he worked on fixing the issue everyday for months.

“When your loved one is already declining in health and you know that your loved one could pass away any day, that by itself is enough stress without having to continually chase down government offices and officials,” he said.

After his mother died, Hamilton received a bill for roughly $60,000. South Peninsula Hospital covered the cost of his mother's care with the understanding that it would eventually be reimbursed by Medicaid.

Director of the Division of Public Assistance, Monica Windom, said because of the increased caseload, the division has struggled with staff turnover. The division requested funding from the Legislature for roughly 40 positions to help reduce the mountain of applications needing attention, but the division was awarded funding for 20.

Windom said that’s better than nothing and that there are other ways the division is working on decreasing the backlog. She adds that the division is still forced to make tough decisions.

“We had to make the decision, do we answer the phone or do we work the benefits? I mean if we take 10 people off of working benefits to answer the phone, then our backlog increases,” she said.  

Back at Torres’ home, she’s still waiting to hear back about her application roughly one month after re-submitting her paperwork.

“One of my biggest frustrations is, I'm a taxpayer," she said. "I've paid a lot of money into the system, and now I have a child that needs the services that are provided by our government, which I'm very appreciative and thankful for. But I just feel like, why do I have to fight for them?”

Torres is also looking at alternatives, such as insurance through her work, but she said that will still leave her footing the bill for some of Zachary’s care.