NJ Spotlight

Healthcare Advocates Not So Sure Insurance Sign-Ups Will Go Smoothly

NJ Spotlight — Tuesday, September 10, 2013

By Andrew Kitchenman

Maura Collinsgru, health policy advocate for New Jersey Citizen Action, at a rally last month. She is concerned that state welfare offices won't be able to help thousands of residents determine whether they're eligible for Medicaid or for subsidized insurance through the federal ACA.

Many New Jersey residents could encounter unnecessary detours on the path to obtaining health insurance either through Medicaid or the new Affordable Care Act marketplace exchanges, despite the federal government's emphasis on having "no wrong doors" as people explore their coverage options.

As the October 1 registration date looms for people to begin signing up for coverage slated to start January 1, healthcare advocates are seeing potential problems that could prevent applying for insurance from being a seamless process. One example they cite is the lack of needed additional funding for county welfare offices expected to help enroll the hundreds of thousands of state residents newly eligible for Medicaid or subsidized coverage through the ACA.

Some health policy analysts blame Gov. Chris Christie's decision to not have a state-run exchange for reducing the amount of time that state officials had to plan ways to make it easier for residents to determine which coverage they are eligible for and then sign up for it.

State officials disagree, saying the system will still work, since people deemed not eligible for Medicaid will have their information forwarded by the welfare offices to the marketplace exchange, where they will be able to purchase insurance later.

The 2010 Affordable Care Act expands health coverage through two primary methods: the marketplace, in which residents will be able to buy one of several different health plans and learn whether they are eligible for insurance subsidies, and expansion of Medicaid eligibility for all low-income citizens and documented immigrants.

In the three and a half years since the law was enacted, President Barack Obama and federal health officials have emphasized that people would be able to use the marketplace website to enroll either for Medicaid or insurance coverage through the exchange.

However, while county welfare officials will use a new statewide computer program to guide residents through enrolling in Medicaid, they won't be equipped to help those who have too much income for Medicaid to enroll through the marketplace.

While it's not the job of county workers to enroll residents in the insurance exchange, the process can flow more seamlessly in states operating their own exchanges, according to healthcare advocates. That's because state officials in those places have had time to plan and coordinate their efforts.

While the marketplace insurance application can be completed online, by phone or by mail, it's expected that many uninsured people will need in-person assistance on the applications.

New Jersey Citizen Action health policy advocate Maura Collinsgru said yesterday that those doing public outreach should direct residents whose income status is unclear to someone who can help them enroll directly through the marketplace — such as federally funded nonprofit "navigators" trained in the application process — rather than to county welfare offices.

"There won't be anyone in the welfare offices to take them to the next step," Collinsgru said. "We're concerned that the people will be lost if they can't just complete the process in that office."

Collinsgru spoke at an event in Camden for nonprofit officials who will be doing public outreach and assisting residents with the marketplace. U.S. Secretary of Health and Human Services Kathleen Sebelius telephoned into the event to encourage the workers.

The income cutoff for Medicaid is being raised from roughly 24 percent of the federal poverty line to 138 percent of the poverty line. The new limit currently amounts to $15,856 for single residents and $32,499 for a family of four.

People with income between those levels and 400 percent of the poverty line — which is currently $45,960 for single residents and $94,200 for a family of four — will be eligible for federal subsidies to buy insurance through the marketplace.

Documented or legal immigrants must wait five years to be eligible for Medicaid but will be eligible for insurance through the marketplace immediately. Undocumented or illegal immigrants will not be eligible for either form of insurance, but will be eligible for care through the state's federally qualified health centers.

The number of state residents with health insurance is expected to increase by roughly 444,000, according to the Rutgers Center for State Health Policy.

State Department of Human Services spokeswoman Nicole Brossoie said in a statement that officials "don't discourage any available avenue to health insurance" for residents.

"There will be no wrong door for access to health insurance," Brossoie said, noting that residents can apply at njfamilycare.org, by phone or in person at a county welfare agency.

"If that person is not eligible (for Medicaid) because of income, his/her information will be referred/forwarded seamlessly to the federal marketplace for processing," she said

But the potential difficulty in helping those people is a concern, according to Raymond J. Castro, senior policy analyst for New Jersey Policy Perspective, a nonprofit focused on the needs of low- to moderate-income families.

"This was decided earlier on, that the county welfare agencies would only process applications that were Medicaid eligible," Castro said. "The state did not appropriate any additional funding for that purpose. Even if the state had, the counties would have presumably also been required to raise funding as well, because it's a shared issue."

Castro added that county agencies will "have their hands full" with the Medicaid eligibility expansion.

"From a delivery of service point of view, this is not a way to run a railroad - this essentially means this person's going to have to apply again," if they need in-person assistance, Castro said.

"I argue that it conflicts with the spirit of the no-wrong-door approach, but the state is in technical compliance" with the policy, he said.

Castro added that there will be relatively few "navigators," the nonprofits expected to provide much of the in-person assistance with the marketplace.

Castro said officials in states that chose to operate their own exchanges had years to plan for the transition between assistance with Medicaid and assistance with the marketplace.

Christie cited the potential cost of an exchange, as well as a lack of information from federal officials about exchange details in justifying his decision.

Collinsgru cited another issue linked to Christie's decision: It left New Jersey with tens of millions of dollars less than other states that decided to run their own exchanges. For example, Maryland — while a smaller state — received $24 million in federal funding to help residents sign up for insurance through its state-operated exchange, while New Jersey's navigators received only $2.02 million.

Both Collinsgru and Castro expressed hope that state officials will find a way to make it easier for those who go to county welfare offices but aren't eligible for Medicaid, perhaps by allowing navigators to be located in the welfare office buildings.

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