Thousands of Coloradans may not be receiving the healthcare benefits they desperately need to live this Thanksgiving, because of backlogs and technological issues within the state’s Medicaid verification systems.
This comes after the federal government required Medicaid eligibility verification again after a two-year pause during the pandemic.
Sources tell CBS News Colorado that one reason for the problems stems from tech issues with Colorado’s systems for Medicaid processing, that the patient’s portal, called PEAK, is not properly communicating sometimes with the portal that state and local staff use, called the CBMS, or the Colorado Benefits Management System.
Even though the state’s website says Medicaid coverage will be turned back on for anyone who turns in the proper paperwork 90 days after losing coverage, CBS News Colorado found that hasn’t been the case for everyone.
Some residents in assisted living homes, and their families, say they are desperate for answers.
“I don’t have what I need to get my heart checked to go through the doctor visits, because that’s important to me to live, I must live,” says Arnett Fugett, a resident in an assisted living home in Arvada. “I came this far, and along the way I knew there was going to be bumps in the road, but for Medicaid to deny me, it’s just outrageous.”
Fugett sustained a traumatic injury following a car accident. He was on his way to deliver food to the needy when another driver had a seizure while driving and ran him off the road.
“When he struck me, I was really, really shocked, to say the least, and because of that, that accident changed the trajectory of my future,” Fugett said.
Fugett had to relearn how to walk and talk, and now his assisted living center, Flourish Supportive Living, is helping him relearn the everyday tasks necessary to take care of himself — like taking out the trash and washing dishes.
“I do those sorts of things that will enable me to foster that kind of growth. So when I do move out, I could take care of myself,” he said.
It costs money to live there, something that’s supposed to be paid for by Medicaid.
But after the federal government reinstated its requirements for Medicaid eligibility verification, he was one of many people who say they didn’t receive notices and missed deadlines for reapplying.
Fugett says once he says he filled out the proper paperwork and reached out to the Jefferson County Human Services Department regularly, they still haven’t been turned back on.
Flourish is paying out of pocket for his living costs until he gets his benefits back, but he says no one with the county or the state can give him any answers as to when that might be or what else he should do to speed up the process.
He’s not alone.
Charlene Harrison’s son, Zach Boyd, is also in assisted living, recovering from a traumatic brain injury. He was shot in the head while serving in the Marine Corps.
She says her son’s Medicaid has been turned off for months, and she can’t get through to anyone helpful with county human services to rectify it. She says she never received any notices in the mail about Medicaid changes, either.
“I’ve been trying to be on top of this,” Harrison said. “They don’t respond, and they don’t take care of anything, they keep giving me the runaround.”
The most recently available state data shows more than 8,700 people lost their Medicaid benefits in Colorado in September for “procedural reasons” like what Harrison’s son and Fugett are dealing with, and more than 53,000 other Medicaid renewal applications were still pending.
Fugett said if he could speak directly to administrators at the state level, he would say:
“Please have a heart, and consider me, so that I can receive my Medicaid, so I can get the treatment I need to get better. And I need your help. Look at the paperwork and process it and say, okay. Because without my medication, without my doctor’s visits, I am going to fail. There’s thousands of people that need assistance. They need their adequate help, and with you deciding their fate, I pray that you do the right thing.”
Jeffco Human Services, which helps processes claims like Fugett’s in Arvada, declined an interview for this story, but says it recognizes there’s a serious backlog for verifying Medicaid benefits right now, and while they’re fully staffed, they are still training people to process Medicaid benefits appropriately. They also say they’re meeting with nursing home and assisted living centers to try to clear Medicaid benefits in bulk, and work through the backlogs faster.