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Managing Medicaid

Internet Sign-Up Inches Forward.

Online enrollment for Medicaid and State Children's Health Insurance Programs is spreading. Eight states now operate Internet-based sign- up, and eight more have pilot projects underway.

Security and documentation are sticking points, however. According to a recent report from the California HealthCare Foundation, automation advancement is uneven and not yet providing many of the state programs with money-saving efficiencies.

Web-based services vary. For some states, online enrollment is simply having an application available for a potential beneficiary to download, fill out and mail. Others allow an applicant to fill out the form online, but once it is electronically mailed to the state, it is printed out and processed like a paper document.

Automation flows end to end for a few states. A program funnels the information from the applicant's online form into the database. That is where the administrative savings come in, but that process is more difficult to develop. So far, California is the most automated state, says Kirsten Wysen, the report's author.

Keeping people in the process is another electronic challenge. More than one-third of online applicants fall out when they have to download, print and mail the application. Many don't have access to a printer.

The federal requirement on documentation is also a barrier to online efficiencies. "It's really a pain to have to collect pay stubs and read those itty bitty bits of paper that verify income," Wysen says. But the "killer for these online applications," she notes, is the federal law requiring a written signature for Medicaid.

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