Backlog of NJ FamilyCare Applications Bogs Down County Office Staffs

Healthcare advocates now advise low-income state residents to apply for Medicaid coverage through the federal ACA website

Camden County Board of Social Services Director Shawn Sheekey.
Thousands of New Jersey FamilyCare applications have piled up in county welfare offices across the state, as small staffs have been overwhelmed by the waves of people seeking health coverage as key provisions of the Affordable Care Act have been implemented.

For example, the Camden County Board of Social Services still hasn’t processed 5,800 applications out of more than 10,000 it received between October and March.

While statewide figures are not available, interviews with healthcare advocates indicate that it’s a widespread problem.

FamilyCare is the state Medicaid program, serving low-income residents.

In the last three months of last year, when the federal website was not functioning well, many healthcare advocates recommended applying for Medicaid or health insurance at county welfare offices instead of the federal site. But now, with the federal site working well, they are telling people to apply online rather than in person.

State and local officials say they are working to speed up processing of the county applications, including having the state provide part-time staff to supplement the county workers.

But advocates say these steps aren’t enough and that the state should take more dramatic steps to resolve the issue.

Of more than 276,000 New Jersey residents who were approved for Medicaid in recent months, roughly 92,000 have received their insurance cards, state officials said. This total includes those who applied through, the federal health insurance marketplace website.

“It’s a public policy problem that is happening across the country,” said Elizabeth Buck, program manager for the Camden Coalition of Healthcare Providers.

People who are eligible for FamilyCare and who are waiting for their applications to be processed will be reimbursed for any healthcare costs they incur. Under the state’s “presumptive eligibility” policy, hospitals and federally qualified health centers take FamilyCare applications and provide healthcare to residents.

But advocates say that many patients are avoiding seeking healthcare because they’re unsure of their status. If the pace of application processing isn’t increased, it could take several more months to complete the process.

“It’s a problem — it’s really unacceptable,” Buck said.

The issue drew the attention of U.S. Sen. Robert Menendez, who who recently grilled outgoing Health and Human Services Secretary Kathleen Sebelius about the issue.

Camden County Board of Social Services Director Shawn Sheekey said his staff is working closely with state officials to address the backlog. He said the board is redeploying staff members who have worked on Medicaid in the past to supplement the six workers who normally process applications. The county also is getting two part-time workers from the state to help with applications.

“We knew it was going to be more than what we typically see in a month,” Sheekey said, referring to the expansion in Medicaid eligibility under the ACA that led to the increase.

The Medicaid expansion covered people with incomes below 138 percent of the poverty line, which amounts to $15,856 for a single person. Previously, a childless, single, employable adult was only eligible if his or her annual income was below $2,520.

Sheekey said his staff has been working to “streamline” the application process.

But the process is cumbersome. Thanks to delay in implementation of the state’s new computer system that will be used to process all human-services applications, workers must process the applications manually.
In addition, county workers must check each application to see if it’s a duplicate. Sheekey said 40 percent of the 4,200 applications his staff has processed have been duplicates.

While Sheekey doesn’t have an estimate for how much time it will take to work through the backlog, he said it would be much less time than Buck predicted. He added that board officials believe that the part-time help from the state “will really expedite the processing.” He added that the state is asking the federal government if counties can have a temporary waiver from a federal requirement that they regularly check to see if current FamilyCare recipients are still eligible for the program.

State Department of Human Resources spokeswoman Nicole Brossoie said in an emailed response to questions that the state is working to support all counties by giving them access to administrative support that can help reduce the backlog of applications.

“New Jersey is not alone in its enrollment challenges. Making the choice to expand Medicaid required extensive reworking of the state’s information technology capabilities,” Brossoie wrote.

In the interim, New Jersey “like other states, is operating under a CMS (U.S. Centers of Medicare and Medicaid Services)-approved contingency plan that facilitates the transfer of data from the federally run marketplace through an electronic flat file. CMS has credited New Jersey for implementing every flexibility and option offered to streamline and process cases.”

In addition, more than 100 staff members were added to the call center that answers calls about FamilyCare, in preparation for the expansion.

Maura Collinsgru, health policy advocate at New Jersey Citizen Action, said the challenge in processing FamilyCare applications, combined with the difficulty in finding providers who accept FamilyCare, is a “one-two punch.”

“Many people have been assuming that the problem really rested with,” Collinsgru said. Instead, she said, the slow processing of applications at county offices has exposed a “long-standing problem that’s just been increased.”

Collinsgru said the state must spend money to address the issue.

“This is really a big issue and we are urging the Legislature to take a look at this,” she said.

“Consumers who are applying to these benefits are waiting months and months and months with no word, no insurance coverage that they know of,” Collinsgru said. “They’re holding off on getting treatment, they’re holding off on seeing doctors, and it’s just going into this big black hole, and the state has been largely silent on what it’s been doing if anything to address the backlog.”

In addition to using the federal site, people can apply for FamilyCare coverage through the state website,, or by calling (800) 701-0710.