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Tue November 12, 2013
Shots - Health News

Medicaid Questions Slow Insurance Purchases On Colorado Exchange

Originally published on Wed November 13, 2013 3:39 pm

If you want to meet somebody who's really happy with the Affordable Care Act, then say hello to Sue Birch, Colorado's Medicaid director.

Nearly 40,000 Coloradans signed up for health coverage on the state's new marketplace, Connect for Health Colorado, rather than HealthCare.gov.

And, Birch says, most of those people who signed up through the website enrolled in Medicaid.

So while Colorado has been enrolling only about a thousand people a week in new private health insurance since its Obamacare marketplace opened, the number enrolling in Medicaid is 10 times that.

"We're pleased that those numbers add up to right under 40,000, and that makes us one of the successful states in the country," she says. "We are certainly one of the big successful states. That's seen as a shining example of functionality."

But not everyone sees the process that way. Some people are complaining that Colorado's Medicaid system is getting in their way, slowing enrollment in private coverage. That's because nearly everyone buying on Connect for Health has to file a Medicaid application first, even if they know they make too much money to qualify.

Cancer patient Donna Smith told the Connect for Health board she's been waiting more than a month to be cleared by Medicaid, so she can buy private insurance for next year.

"This is a very real human issue, and day 36 is making me really nervous," she says.

Stories like that are troubling to Connect for Health board members including Ellen Daehnick.

"Getting through the system can be more complicated and time consuming than necessary, and there can be points where a user has to wait," she says.

Daehnick and other board members worry that people who won't qualify for Medicaid but will qualify for tax credits to lower their private insurance premiums will get hung up in the Medicaid application and not come back.

Judy Solomon, with the Center for Budget and Policy Priorities in Washington, says Colorado appears unique in the way it has fashioned the Obamacare application.

"If Colorado is trying to make sure that no possible door to Medicaid has been foreclosed before passing people on for the premium tax credits, it's really going to slow down the process," she says.

Connect for Health board members got a feel for that last week during a demonstration of the site. The application included questions about how much a person's car is worth, and whether someone has burial benefits.

Questions at that level of detail are designed to screen for every possible Medicaid recipient, but aren't required for the vast majority of people shopping for Obamacare coverage. Those questions have since been removed from Colorado's application.

Connect for Health Colorado's board chairwoman Gretchen Hammer says the application still isn't as streamlined as they'd like, but she's not convinced it's pushing people away.

"We are seeing a number of Coloradans who have not had access to coverage before, get that access and get it in a fairly timely manner," she says.

Hammer says she's aware some people are getting hung up, but doesn't think that's the only reason only 3,400 people bought private coverage through Connect for Health Colorado in its first month.

She says she thinks a lot of people may be waiting to buy because they can't afford something now that won't go into effect until next year. People can wait until Dec. 15 to buy coverage that starts on January first.

But she admits that Colorado's application process could be a lot more efficient, and the Connect for Health board is working on a major fix for next year.

Meanwhile, Connect for Health is hoping its sales rate goes up significantly. The 3,400 people who've bought coverage so far are a long way from the 136,000 the state is aiming for by the end of March.

This story is part of a reporting partnership between NPR and Kaiser Health News.

Copyright 2013 NPR. To see more, visit http://www.npr.org/.

Transcript

ROBERT SIEGEL, HOST:

And we turn now to Colorado, where signing up people for health care coverage has been slow going but it's not just a software problem. Colorado requires most consumers to fill out a long Medicaid application before they can sign up for insurance under the Affordable Care Act.

As Eric Whitney reports from Denver, the multi-step process has made it even harder for people to sign up for health insurance.

ERIC WHITNEY, BYLINE: If you want to meet somebody who's really happy with the Affordable Care Act and how it's connecting people to new health coverage, both public and private, meet Colorado's Medicaid director, Sue Birch.

SUE BIRCH: We're pleased that, again, those numbers add up to right under 40,000, and that makes us one of the successful states in the country.

WHITNEY: Nearly 40,000 Coloradans signed up for new coverage, using not healthcare.gov but the state's new marketplace, Connect for Health Colorado. And Birch explained at a Connect for Health board meeting, most of the people who signed up through the website actually enrolled in Medicaid.

BIRCH: We are certainly one of the big successful states that is seen as really a shining example of functionality.

WHITNEY: But a shining example of functionality is not what everyone is experiencing. Some people are complaining that Colorado's Medicaid system is getting in the way of them enrolling in private coverage. That's because nearly everyone buying on Connect for Health has to file a Medicaid application first, even if they know they make too much money to qualify.

Cancer patient Donna Smith told the Connect for Health board she's been waiting more than a month to be cleared by Medicaid so she can buy private insurance for next year.

DONNA SMITH: This is a very real human issue and day 36 is making me really nervous.

WHITNEY: Stories like that are troubling to Connect for Health board members like Ellen Daehnick.

ELLEN DAEHNICK: Getting through the system can be more complicated and time consuming than necessary, and there can be points where a user has to wait.

WHITNEY: The Medicaid application is a significant problem, Daehnick and some other board members agree. They worry people who won't qualify for Medicaid but will qualify for new tax credits to lower their private insurance premiums will face delays and not come back.

Judy Solomon with the Center on Budget and Policy Priorities in Washington says Colorado appears unique in its style of Obamacare application.

JUDY SOLOMON: If Colorado is trying to make sure that no possible door to Medicaid has been foreclosed before passing people on for the premium tax credits, it's really going to slow down the process.

WHITNEY: Connect for Health board members got a feel for that last week when their site's online application was demonstrated for them.

UNIDENTIFIED MAN: Is your Ford Mustang registered? Yes. What is the primary use? To get to work.

WHITNEY: It included questions about how much a user's car is worth and whether they have burial benefits. Questions at that level of detail are designed to identify every possible Medicaid recipient but are not required for the vast majority of people shopping for Obamacare coverage. Those questions have since been removed from Connect for Health Colorado's application.

Connect for Health's board chair, Gretchen Hammer, says the application still isn't as streamlined as they'd like but she's not convinced it's pushing people away.

GRETCHEN HAMMER: We are seeing a number of Coloradans who have not had access to coverage before get that coverage and get it in a fairly timely manner.

WHITNEY: Hammer says she's aware some people are getting hung up but doesn't think it's the only reason only 3,400 people bought private coverage through Connect for Health Colorado in its first month.

HAMMER: I don't know that we have enough evidence to draw a direct one-to-one correlation.

WHITNEY: Hammer says she thinks a lot of people may be waiting to buy because they can't afford something now that won't go into effect until next year. People can wait until December 15th to buy coverage that starts on January 1st. But she admits that Colorado's application process could be a lot more efficient, and the Connect for Health Board is working on a major fix for next year.

Meanwhile, Connect for Health is hoping their sales rate goes up significantly. The 3,400 people who've bought coverage so far are a long way from the 136,000 the state is aiming for by the end of March.

For NPR News, I'm Eric Whitney in Denver.

SIEGEL: And Eric Whitney's story is part of a reporting partnership of NPR and Kaiser Health News. Transcript provided by NPR, Copyright NPR.

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