Medicaid applications from overloading VA system


MEDICAID BACKUP: There’s a major backlog of Medicaid applications and cases at the state level, and that’s fueling fears that VA may not be ready for expansion.

By Kathryn Watson |, Virginia Bureau

ALEXANDRIA, Va. — With Medicaid expansion in limbo, the Virginia Department of Social Services already is backlogged and working overtime to handle the 50,000 applications directed to the state from

Problems at the federal level meant Virginia didn’t begin receiving those applications until Feb. 18 — nearly five months after the site went live.

The Department of Social Services has hired temporary staff, and some DSS employees are working nights and weekends, said Necole Simmonds, director of public affairs for the Department of Social Services. It’s likely some people submitted more than one application out of frustration with the slow process and that many aren’t eligible for expansion, as Virginia hasn’t chosen to expand coverage, Simmonds said.

“Going forward, we continue to make system enhancements that we believe will maximize opportunities for applicants to have self-directed eligibility determinations — an eligibility determination that can be accomplished without a human touch using the federal hub data to determine eligibility,” Simmonds said via email. “We believe that this is critical as we move forward to cover the health insurance gap.”

Still, it’s a backlog that gives some weight to the fears of Republicans who say Medicaid expansion, which would add anywhere from 200,000 to 400,000 people to a program with about 1 million enrollees currently, would overwhelm the system.

With a Saturday budget deadline looming, Richmond is at a standstill.

The Senate proposed its own version of Medicaid expansion, but the House shot it down. House Republicans proposed expanding the session by 30 days to work out a deal, but Senate Democrats killed it. That leaves mere hours for Republicans and Democrats to reach a compromise, or end the session without a biennial budget and return later.

Medicaid applications ultimately are processed in each of Virginia’s more than 100 Department of Social Services offices.

“There’s no doubt that if they were to expand, we would need additional help,” said Joanna Spar, benefits programs supervisor at the Roanoke County Department of Social Services.

Expansion or not, that workload probably will increase when the backlogged applications from trickle down from the state, she said.

“The applications and cases have increased a little bit because what we’re finding with the new health care reform and what the government is imposing for those that don’t have health benefits, we’ve had an influx of those who have applied,” said Spar, even if applicants don’t ultimately qualify for coverage.

There’s a difference between the number of applications and actual cases. Applications are simply the number of people who apply for Medicaid, while cases represent Medicaid enrollees.

In Spotsylvania County, expansion could mean another 3,000 to 5,000 eligible people — and probably even more than those who would apply in hopes of being eligible, said Gail Crooks, director of the Spotsylvania Department of Social Services. Crooks said her office is always looking to be more efficient, but expansion would demand more hands on deck.

“Would we need help if they went to Medicaid expansion? I believe we would,” Crooks said.

She has added two benefit eligibility workers to her budget request.

“The primary reason for the request was while we could certainly put them to use right now, they were primarily tied to the possibility of Medicaid expansion,” Crooks said.

But in Spotsylvania, recent applications and enrollment haven’t necessarily spiked with the health-coverage requirement under the Affordable Care Act. Rather, her office experienced massive increases during a population boom in the early 1990s and early 2000s, and after the Great Recession hit in 2008.

“We as a locality have been experiencing increases in caseload for quite a while,” Crooks said.

Terry Rephann, a regional economist with the University of Virginia’s Weldon Cooper Center for Public Service, has researched the labor impacts of expansion on various areas of Virginia’s economy. While he hasn’t researched the specifics for local Departments of Social Services, he said expansion would require more people to handle applications and cases.

“If you’re just talking about people who do the paperwork, I would imagine it would have to increase because you have a lot more people who are going to be eligible,” Rephann said. “But how much they’re going to have to increase the budget to accommodate, that I don’t know.”

Kathryn Watson is an investigative reporter for, and can be reached at

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