State Medicaid backlog hampers healthcare on the southern Kenai Peninsula
Here in Homer, Monica Anderson is a patient benefits coordinator at Seldovia Village Tribe’s Health and Wellness center. She has patients who applied for SNAP, Medicaid and Senior Benefits back in September, and are still waiting to hear from the state’s Division of Public Assistance.
The delays in providing access to the governmental healthcare program are part of an ongoing state backlog at the Division of Public Assistance in processing benefit applications. The agency is aware of the problem, and recently hired new employees and contractors to try to alleviate these issues. But in the meantime, long wait times for Medicaid applicants are preventing people from getting the healthcare they need.
Anderson said that historically, SVT could reach out directly to the state to get cases expedited, but now she has to navigate the same barriers as patients.
“My hands are tied. I have to call the virtual call center as well,” Anderson said. “I don't have a fancy ‘phone a friend’ direct contact.”
The local DPA office in Homer closed during the COVID-19 pandemic, which meant everyone had to go through the virtual call center, which has been understaffed since the Dunleavy Administration cut 100 positions from the division in 2021.
When making calls on behalf of these patients, it can often take hours, and often doesn’t yield results.
“It's having to go through sometimes getting bounced from the person who takes the call, then we get in another queue to talk to an eligibility technician,” Anderson said.
As a community health center, SVT offers treatment on a sliding pay-scale. But when patients waiting for Medicaid approval need referrals to outside specialists, they have to pay out-of-pocket. That’s where patients are having to make difficult decisions about their healthcare, Anderson said.
“They're holding off seeking medical attention the provider might feel is urgent, but they feel like they can't afford — to travel to Anchorage or afford the office visit — not knowing how much longer their application might be [pending],” she said.
Throughout the COVID-19 pandemic, the Division of Public Assistance provided continuous coverage for the more than 260,000 Alaskans who receive Medicaid, according to Heidi Hedberg, commissioner of the Alaska Department of Health. But there has been a months-long delay in processing new applications.
Deb Etheridge is the director of the Division of Public Assistance, and said many new applicants simultaneously apply for other benefits, creating duplicate forms that need to be processed individually. This means the state doesn’t have an accurate sense of how many Alaskans are facing delays in getting their medical benefits.
Etheridge said the agency is working to hire more eligibility workers, and current staff are working overtime and weekends.
“It's not a situation we wanted. No one feels great about it,” Etheridge said. “They're just working really hard to be out of this.”
Derotha Ferraro is a spokesperson for South Peninsula Hospital in Homer. She said this backlog is impacting patients in a number of ways, and estimates they’ve had at least 60 to 70 patients in the past six months who’ve struggled to get Medicaid coverage.
Despite the delays, the hospital is able to offer those patients care through something called “presumptive eligibility,” or temporary coverage for patients who meet the criteria for Medicaid, before their applications are approved. But that coverage only extends for a maximum of two months, and is only available to a patient once a year.
“So if you've already [had] temporary coverage, and that window closed for you, but Medicaid has not approved you officially for Medicaid coverage, you’re uninsured again,” Ferraro said.
Even patients who do have Medicaid coverage are facing waits of up to a month in getting prior authorization for procedures like MRIs, she said. Whereas with other insurers, it might be a few hours or days, if they require prior authorization at all.
For new Medicaid applicants, Ferraro said the hospital is seeing delays of six months or more for the Division of Public Assistance to process applications.
“And that's too long, because usually when somebody's seeking healthcare, and they qualify for Medicaid,” Ferraro said, “things aren't going well for them.”
Annette Hubbard, a case manager for opiate use disorder services at Ninilchik Community Clinic, said these Medicaid wait times are keeping patients from accessing essential care. She’s run up against the same delays as the medical centers in Homer while helping patients through the Medicaid application process, even for requests for urgent and emergency coverage.
“[Patients have] called multiple times, we've called Medicaid multiple times, we have sent in emergency letters to see about getting Medicaid to cover their visits or the medications. We send documentation for the patients — because for some people, treatment can be life or death,” Hubbard said.
Even when people do get approved for Medicaid, while they can be reimbursed for doctors visits, Hubbard said, in her experience, that isn’t necessarily true of medications.
“Some of these medications that people are on are life-saving, life-altering — help get them stable,” Hubbard said. “They cost anywhere from $100 a week to $2,000 a month.”
Many of Hubbard’s patients simply don’t have the money to spend $250 on a weekly doctor’s visit out-of-pocket, much less for medication on top of that — even if some of their expenses will eventually be reimbursed by Medicaid.
In spite of all of her outreach to the Division of Public Assistance, Hubbard said it doesn’t feel like patients’ applications are moving any faster.
“It still feels like it's a brick wall.”
Anyone waiting more than 30 days for a response about a Medicaid application can file a complaint with the Alaska State Ombudsman, or reach out to Alaska Legal Services for help filing a request for a fair hearing.
Starting April 1, the Division of Public Assistance will start requiring some Alaskans to recertify their coverage for the first time since the COVID-19 pandemic began. To help with the process, Deb Etheridge, with DPA, suggested Medicaid recipients make sure to update their contact information and any change in address online.
For people who would like to talk to a representative in person, the Division of Public Assistance office recently reopened in Homer on Tuesdays, Wednesdays and Thursdays from 9 a.m. to noon and 1 p.m. to 4 p.m.