DENVER Colorados Medicaid program has had significant delays in determining applicants eligibility, according to a federal review released Tuesday that raised the question of withholding money from the state if problems are not solved.
The review from Centers for Medicare and Medicaid Services also found that Colorados system does not provide sufficient time for applicants to show proof of citizenship and is not programmed to deny or terminate benefits to those who dont qualify.
The report presented to lawmakers in the state audit committee said Colorado is not complying with federal regulations that call for eligibility to be determined within 90 days for people with disabilities or within 45 days for all other applicants. The report said about half of all applications are not processed within the federal timelines.
State officials responded that theyve made system improvements and now 80 percent of all applications are processed in time.
Were getting to these higher grades, said Sue Birch, the executive director of the Colorados Department of Health Care Policy and Financing, which administers health care programs.
Still, some lawmakers questioned officials about the reports warning to withhold federal funds from the state system that determines Medicaid eligibility if officials dont solve the problems. The Colorado Benefits Management System is the system that would lose federal money.
The threat of losing federal support here is a major, major concern, said Denver Democratic Sen. Lucia Guzman said.
Birch said federal officials are not taking a threatening tone.
Theyve come in a pleading tone, but there have never been any direct sanction discussions, she said.
Lawmakers also criticized the Colorado health care department because in the past four years state auditors have cited many of the concerns mentioned by the federal report and proposed solutions have not been implemented, even though the department agreed to the recommendations.
But agree must mean something different, said Greeley Republican Sen. Scott Renfroe.
Sen. Steve King, a Republican from Mesa County, at one point asked Birch whether officials could say which past recommendations have been implemented.
Are there any that we can check the box on? King asked. Birch responded: I can assure you in the next 18 months the boxes will be checked.
The review blames past delays in part to the state benefits system. But the state Office of Information Technology told lawmakers that an upgrade to the system that would speed up processing was completed in December, at about the time the federal review was completed. The reviewed was done from July 1, 2010 through Dec. 7, 2010.
State health care officials say theyve also had to deal with unprecedented levels of Medicaid enrollment because of the Great Recession.
The review said Colorado must comply with a federal law allowing people enough time to present proof of citizenship for eligibility, and that applicants should receive benefits while their claim is being processed. However, the review said Colorados system is not designed to deny or reject applicants if they dont provide documentation in a reasonable time. State officials said theyre working on a solution.