One of the goals of the Patient Protection and Affordable Care Act (ACA) is to integrate eligibility and enrollment for applicants for both commercial health plans sold in the state health benefit exchange marketplace as well as state subsidy programs for poor and low income households including Medicaid and the Children’s Health Insurance Program (CHIP). The idea is to reduce the ranks of the medically uninsured by making it easier for people to get covered with a single, streamlined application process referred to as “no wrong door.” Applicants are more likely to sign up for coverage if they don’t have to contact multiple entities to get it.
The requirement is set forth in Section 1413 of the ACA. Section 1413(c)(1) requires each state to “develop for all applicable State health subsidy programs a secure, electronic interface allowing an exchange of data (including information contained in the application forms described in subsection (b)) that allows a determination of eligibility for all such programs based on a single application.”
In the three dozen states where the federal government is operating the state exchange marketplace, online eligibility and enrollment is being handled by the federal web portal. Problem is according to today’s Washington Post, the portal isn’t yet able to integrate with the state subsidy programs:
But in a phone call Tuesday with the nation’s state Medicaid directors, Marilyn Tavenner, director of the Centers for Medicare and Medicaid Services (CMS), the agency overseeing the exchange, said that this part was still not working and did not predict when it would be ready, said Matt Salo, executive director of the National Association of Medicaid Directors. In the meantime, the Web site simply tells low-income Americans whether they appear to be eligible and then advises them to contact their state’s Medicaid agencies, where they must start applications from scratch.
The Post story details the implications of this glitch:
The Web site’s Medicaid problems matter because, under the health-care law, about half of the 32 million Americans who stand to gain insurance are expected to be covered through the state-federal health program for the poor and the disabled. The Web site is designed to tell people, depending on their income, whether they are likely to qualify for Medicaid or new federal tax credits to help them pay for private insurance. The site steers consumers in one direction or another after they enter information, including their family size and income. That part works.
Here’s the snag: If the Web site determines that a consumer probably qualifies for Medicaid, it cannot communicate with a state Medicaid program for quick enrollment. Instead, the site gives the person a message to contact the state’s Medicaid program. Then the person has to “start all over again,” said Salo of the Medicaid directors association. He added that the malfunction is “a frustration…It can turn [consumers] off and make them angry about how government works.”
Likely complicating enrollment for those eligible for state subsidy programs is a crazy quilt patchwork of Medicaid eligibility standards, dependent upon whether the state has opted to expand Medicaid eligibility as authorized by the ACA as well as varying income eligibility levels in states that have opted out of the Medicaid expansion as detailed in Table 1 of this recent Kaiser Family Foundation report (.pdf)
Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email