April Merrill has lost track of the number of phone calls she has made, trying to get young people signed up for Medicaid.
There was the young man who had a painful abscess in his mouth and was having trouble communicating at work.
There was the young woman who could no longer afford her mental health medication after she no longer had Medicaid coverage.
An estimated 2,300 former foster youth — these two examples included — are now eligible to remain on the state’s Medicaid program until age 26.
Some advocates are worried, however, that not enough former foster children are being enrolled into the program.
That change in eligibility is thanks to a provision of the Affordable Care Act, or Obamacare, that expanded the Medicaid program to allow young people who were in foster care when they turned 18 to remain on the state health insurance coverage plan until age 26.
The change went into effect Jan. 1 of this year.
Since that time only a fraction of Oklahoma’s former foster care youth have been enrolled in Oklahoma’s Medicaid program. Merrill and other advocates say computer glitches have caused many applicants to be denied.
Like the woman who could no longer afford her medicine. Without her medication, she was having thoughts of harming herself, Merrill said.
“At one point, she called me and said she was scared of what would happen if she didn’t get health care soon,” said Merrill, lead attorney for the medical-legal partnership initiative at Legal Aid Services of Oklahoma.
During the past eight months, coding issues between state agency systems have caused some eligible foster care youth to be denied when they apply.
Although agency officials say the system’s glitches are worked out, Merrill and other advocates have voiced frustration with the process.
“I still have kids who are being denied,” Merrill said. “If they fixed the entire problem, how is it possible that I still have kids being denied?”
The Oklahoma Health Care Authority, the state’s Medicaid agency, and the state Department of Human Services have worked together to implement the eligibility changes.
Katelynn Burns, a DHS spokeswoman, said there have been some initial challenges to the implementation of the online application process.
“DHS and Oklahoma Health Care Authority have been working together to resolve the problems,” Burns said. “An interim procedure has been established. Once DHS child welfare services has been advised that an eligible youth has been denied, an email is forwarded to Oklahoma Health Care Authority. The issue has usually been resolved within 24 hours.”
Jennie Melendez, a health care authority spokeswoman, added that the agency was told about the issues related to using the correct custody codes from DHS to create a way for the authority’s system to recognize the foster care population.
“Since that time, we have made the necessary updates to back-date eligibility where appropriate,” Melendez said.
Oklahoma is not the only state that has faced difficulties in implementing the enrollment changes.
Tricia Brooks, senior fellow at the Georgetown University Center for Children and Families, said she has seen confusion among different states about how to best implement the changes to the Medicaid program to include former foster youth.
“I think some states haven’t quite figured it all out yet, but I’m certainly aware of states that are being more progressive, if you will, in terms of wanting to reach the former foster youth and make it simplified for them to get into coverage,” Brooks said.
To qualify for Medicaid, these youths must be younger than 26 and have been enrolled in Medicaid and in foster care custody under the responsibility of the state or a tribe when they aged out, according to the U.S. Department of Health and Human Services.
Beginning Jan. 1, any former foster youth in Oklahoma who met these qualifications could sign up.
But up until June, many hadn’t.
Agency records show that between Jan 1. and June 30, 117 former foster youth signed up to stay on Medicaid, with 103 of them enrolling in June.
Cathy Connelly, program manager of the Oklahoma Independent Living Program, said that over the past few months she has seen state agency employees work together to resolve the coding issues that caused young people to be denied, sometimes repeatedly.
On Wednesday, Connelly got a text message, telling her about another former foster youth who had been denied on his Medicaid application.
Connelly, who works with foster youth under a DHS contract, used to get texts and calls like this daily. Over the past few weeks, though, that’s decreased to about one per week, she said.
Application denial issues are getting resolved more quickly as the agencies work together and advocates continue to raise awareness of the youth they represent, she said.
“Before we weren’t sure what was happening, and so we weren’t able to respond to them quickly,” Connelly said. “And now, like I said, it was a text I got yesterday until today, and it’s resolved.”
I still have kids who are being denied. If they fixed the entire problem, how is it possible that I still have kids being denied?”
Lead attorney for the medical-legal partnership initiative at Legal Aid Services