A half-dozen states with Medicaid backlogs are facing a federal deadline to create a plan for getting those low-income residents enrolled in health coverage.
The request comes months after the first national sign-up drive under President Barack Obama's health reform law.
The Centers for Medicare & Medicaid Services sent letters last month to Alaska, California, Kansas, Michigan, Missouri and Tennessee asking those states to address gaps in their eligibility and enrollment systems that have delayed access to coverage for the poor and disabled people.
The letters said the states had until Monday to respond. Officials from California, Alaska and Michigan say they are working on their plans.
In California, health care advocates say the backlog is preventing some people from accessing the treatment they need.