The number of people seeking state-subsidized health insurance has overwhelmed the offices processing applications, forcing some of the uninsured to wait months to get coverage, according to state officials and healthcare advocates.
Applicants routinely have to submit the same paperwork twice or even three times, because it is getting lost in state offices, advocates say, and many are getting confusing or contradictory information about whether they qualify.
The loss of paperwork "happens to over 50 percent of our clients," said Camila De Oliveira, program director of the Community Action Committee of Cape Cod & Islands, which helps people apply. "The clients are getting frustrated. It was supposed to be a fast turnaround."
It's not clear precisely how many people are affected, but the resulting delays mean that thousands of people trying to get coverage are not yet in compliance with the new state law requiring every adult to have health insurance by July 1.
The state official overseeing the application process acknowledged the delays and said the state is working to solve the problem.
"What we're experiencing is the stress of success," said Thomas Dehner, director of the state Medicaid program, which is called MassHealth and handles applications from residents applying for either fully subsidized insurance under MassHealth or full or partially subsidized insurance under a new program called Commonwealth Care. "We are seeing an enormous spike [in applications] and processing times are longer than they need to be."
"We can't afford the perception that we are not going to deliver on healthcare reform," Dehner said. "We are going to deliver. It's our highest priority."
A coalition of advocates and healthcare providers that helped get the law passed met with state officials yesterday to discuss the problems.
"We think it's been getting worse," said Brian Rosman, a leader of the Affordable Care Today Coalition.
More than 6,000 people a week applied in the two weeks before and the week after the July 1 deadline, due in part to a statewide advertising campaign.
The volume of applications dropped somewhat this month, but is still nearly double what MassHealth handled last year before Commonwealth Care began. Although MassHealth increased the number of hours staff members devoted to processing applications and added people to answer questions by phone, it has not been enough to keep pace.
When the law passed, officials estimated that between 140,000 and 212,000 residents would qualify for Commonwealth Care and 70,000 to 89,000 for MassHealth. To date, nearly 105,000 people have been enrolled in Commonwealth Care, 21,000 more than projected for July 1, and another 57,000 have enrolled in MassHealth.
The state's goal is to get back to applicants within five days, telling them whether they qualify for either program or must submit additional information.
Dehner said the state is meeting that goal for most of the people who apply electronically. But about half the applications come in on paper, and it is taking an average of 22 days to handle those, he said.
Advocates say some applications are taking far longer, up to several months, because of missing documents or other problems.
Residents who qualify for MassHealth are enrolled immediately. But if the state declares a person eligible for Commonwealth Care, they must still choose a health plan and in some cases pay a premium before they are covered, which can add another month to the process.
For a Yarmouth family, it has already taken two months and will be another month before they have coverage.
Heidi and her husband applied electronically with the help of Community Action on June 4 after learning about Commonwealth Care through news reports. Their recent marriage put her income over the limit, and she was about to lose MassHealth coverage. Her husband, 46, had no insurance. Heidi discussed the family's situation on the condition that their family's last name not be used to protect their privacy.
A few days after applying, they faxed supporting information to the state. For nearly three weeks, they heard nothing.
Then they got separate letters saying that Heidi's teenage son qualified for MassHealth, but that the couple earned too much to get MassHealth and would not qualify for Commonwealth Care, because they had access to insurance through the husband's work.
In fact, the man's employer, an auto salvage shop, does not offer his workers insurance, so the couple faxed in letters to clear up that issue.
"They had all the information, and they didn't act on it," said Cathy Weidhaas, an outreach worker for Community Action who helped the family, making repeated calls to MassHealth.
At the end of July, the family received three conflicting letters, all dated July 25. One said they were denied any coverage. Another said they needed to submit more information, and a third said they had qualified for Commonwealth Care.
Totally confused, they called and were first told they had to reapply because of missing documents. When they protested, the state located the paperwork and said they had been approved for Commonwealth Care.
But it was too late in the month to get coverage for August, so they are eagerly awaiting September. In the meantime, Heidi is paying out of pocket for medications she needs for fibromyalgia and other ailments.
"I never thought it was going to be this difficult," said Heidi, who is 40. "If it hadn't been for Cathy's help, I would have just given up and been without health insurance."
When Weidhaas applied for Commonwealth Care herself, she got an answer in 17 days, but then ran into another problem: The state delayed processing her check for the first month's premium and, as a result, her coverage was postponed 30 days, until Sept. 1.
Earlier this week, the state said that 950 people had faced similar problems with their checks because of a computer glitch, but that the issue was resolved and people would be enrolled retroactive to Aug. 1. Weidhaas's case, which occurred during the same timeframe, suggests there is still a problem, since she has been told she will have to wait.
Although the coverage deadline for all residents has passed, no one will face a penalty if insured by Dec. 31.
To fix the larger issue of eligibility delays, the state is authorizing overtime for MassHealth employees working to reduce the backlog of applications, Dehner said.
In addition, MassHealth is seeking to reduce the paperwork required for applications by allowing electronic signatures. The agency is also retraining workers to be sure they are providing correct and clear information to applicants. MassHealth is also setting up an ombudsman to help resolve individual problems.
"We're really encouraged," said Rosman, after meeting with Dehner. "But we'll wait and see if they deliver on what they say they're going to do."
To get information on eligibility for MassHealth or Commonwealth Care, or to check the status of an application, call 888-665-9993. Information about Commonwealth Care is available at macommonwealthcare.com or by calling 1-877-623-6765. Alice Dembner can be reached at Dembner@globe.com.