Visitors to Healthcare.Gov, the web portal for 34 states that asked the federal government to take the lead on the Affordable Care Act's online marketplaces, were supposed to be able to immediately sign up for Medicaid through the site if they qualified. That goes for people living in states that are expanding Medicaid and those that aren't.
CMS, which manages the federal health exchange, announced before the Oct. 1 rollout that visitors would not be able to sign up directly through Healthcare.Gov until Nov. 1. In the meantime, the website has directed potential new enrollees to their state Medicaid offices. Now CMS is telling Medicaid directors that the website won’t be ready to handle enrollment until after the Nov. 1 date, and it’s offering no timetable for completion, said Matt Salo, executive director of the National Association of Medicaid Directors.
“You can get enrolled, but it’s not a one-stop shop,” Salo said. “You have to back out of Healthcare.Gov and start the process all over again. Is this a catastrophe? No, but it’s really confusing for people.”
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Visitors to Healthcare.Gov, which has struggled with major technical flaws, have the option of purchasing private coverage, possibly with substantial subsidies, or Medicaid, the state-federal program for the poor and disabled, if they qualify. The Medicaid problem has no effect on people signing up for private coverage.
Some of the exchanges among the 16 states that chose to host their own sites have had little trouble with people signing up for Medicaid, and in fact Medicaid recipients have dominated enrollment. But many state-based exchanges haven’t released detailed figures yet.
Among the states that deferred to the federal government, 24 chose to have CMS do an initial assessment of eligibility but to pass on those potential enrollees to the state Medicaid agency for final determination, according to the Kaiser Family Foundation. Twelve states, including some that are expanding Medicaid under the Affordable Care Act, are allowing CMS to make the final consideration.
Regardless, every state Medicaid agency must have the ability to communicate with the federal exchange by Jan. 1. They also have to update income-eligibility systems with a simpler, uniform model that better resembles the adjusted-gross income measurement used by the IRS. Most states have reported aiming for Oct. 1 readiness in Kaiser surveys, but some said they won’t be ready until Jan. 1, and some that said they’d be ready Oct. 1 have missed that deadline, said Eileen Ellis, a consultant at Health Management Associates.
Ellis noted that the deadline for signing up for coverage in time for the Jan. 1 start date is mid-December and that typically income fluctuates frequently for Medicaid beneficiaries anyway.
“I don’t see it as a big deal (yet),” she said. “More just the frustration aspect for people enrolling. It’s disconcerting for people who want to know whether they’ll have coverage.”
Salo said issues with readiness among state Medicaid agencies could hamper the federal exchange’s efforts, but right now the federal exchange isn’t even capable of communicating with states that are prepared.
“I’m sure in the grand scheme of things it’s a little of both, but there is a blanket challenge at the federal level in that the account transfer doesn’t work,” he said.
A CMS spokeswoman directed questions about the department’s timeline to a list of background points that said it’s prioritizing fixes to online application problems and sending lists of potentially eligible consumers to individual Medicaid agencies.
Nearly every state that created its own exchange is also expanding Medicaid to childless adults earning up to 138 percent of the federal poverty level. Even states that aren’t expanding are expecting a bump in enrollment from people who discover they’re eligible under existing requirements when they visit the federal exchange. Some states that created their own exchange have had little trouble signing up new Medicaid beneficiaries through those systems.
Of the 3,700 people who signed up for coverage in Minnesota through Oct. 16, 3,363 qualified for Medicaid or other health programs, according to consulting firm The Advisory Board Company. Connecticut reported 1,950 public enrollees to its 1,897 new private beneficiaries.
Kaiser reports that about 85 percent of Washington's 35,000 signups are with Medicaid, along with two-thirds of Kentucky's new enrollment.
Most recently, New York's exchange reported that nearly 24,000 of the 37,000 enrolled through its exchange qualify for Medicaid under the expansion.
