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43,000 Oregonians waiting for Medicaid approval

PORTLAND — About 43,000 low-income Oregonians are waiting for their Medicaid applications to be fully processed, state health officials say.

The Oregon Health Authority says some of the applications came through the federal government's portal and have been determined eligible for benefits but have not been entered in the state's system; others are still incomplete and stuck in limbo.

About 30,000 applications in the backlog came in through the federal HealthCare.Gov portal. Another 13,000 are new applications that were filed with the state.

The delay in processing, said OHA's Kimberly Mounts, is caused by a larger than normal influx of people who are applying and re-applying, and by a switch in the state's enrollment system. Oregon previously used software developed as part of its insurance exchange, Cover Oregon, to make eligibility determinations for Medicaid.

Oregon ditched the glitch-filled Cover Oregon software last spring and decided to switch to the federal portal. As a result, most people who needed to apply or re-apply for the Oregon Health Plan, the state's version of Medicaid, used the federal portal.

There is a lag of about a week between when a person fills out the application via HealthCare.Gov and when the state receives the file, Mounts said. Some of the files also are missing income or other key information, so the state must reach those individuals and update their files before determining whether they are eligible for benefits.

About 200 people are processing the applications, Mounts said. The health authority must process Oregon Health Plan applications within 45 days of their submission; officials did not say whether any applications crossed that deadline.

Oregonians who have been determined eligible and have a determination or confirmation letter can start using the benefits right away. Even if they don't have a benefits card, the letter can be used as proof of coverage. Pharmacies and providers don't have the obligation to accept the letters, but officials said many do.

If a patient was determined eligible and has to pay out of pocket, the state will retroactively reimburse them for the benefits. But some low-income people can't afford to pay out of pocket. Health care providers say some are putting off appointments or are unable to buy medication as a result.

Officials say the problems are temporary. Next year, the state will be using an online Medicaid enrollment system from Kentucky. A technology contractor still has to customize it for Oregon's use.

Once that's complete, Oregon will use the federal website to enroll people in private insurance and will use the Kentucky software to manage enrollments in the Oregon Health Plan.