Under the Affordable Care Act (a.k.a. the health reform law, or ACA), nearly 6 million people in the United States have gained health insurance coverage under the expansion of Medicaid, The Washington Post reports. However, about 1.7 million Americans are still on a long waiting list to get signed up for Medicaid.

Technical difficulties, such as computer crashes, lack of staffing and website glitches, are the main causes of the delays, according to officials in 15 states. The process has been further complicated because many HealthCare.gov applications are now being found ineligible on certain state exchanges.

The issues vary widely from state to state, regardless of whether the state chose to expand Medicaid. Among those that did, California has nearly 900,000 pending Medicaid applications and Illinois still has to process 283,000 cases, but New York has no backlog. North Carolina, which didn’t expand Medicaid, has about 170,000 pending applications.

Federal law typically requires states to process all Medicaid applications within 45 days, and coverage under the program can be extended back three months before it’s approved. However, many providers refuse to see patients without insurance or demand that patients pay cash up front to be reimbursed later.

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