Posted on 20 November 2013.
By Katie Kerwin McCrimmon
GREELEY — No one mentioned cancellation notices. And no one expressed concerns about costs. Instead, at a sparsely attended public meeting about health insurance issues Tuesday evening, potential customers wanted to know if they could skip filling out Colorado’s complex Medicaid application.
“I heard there’s a form to fill out with income. Someone said there’s a blank you have to fill in about your assets. What is the need for that?” asked Jim Dale, a Greeley retiree who doesn’t qualify yet for Medicare.
Colorado’s new insurance commissioner, Marguerite Salazar, hosted the meeting. Her office doesn’t run Medicaid programs. It regulates insurance companies and approves plans and rates. Still, most consumers wanted to know about holdups with Medicaid and no one from that office attended.
Earlier this month, a state exchange board member called Colorado’s Medicaid application “odious and embarrassing.” (Click here to read ‘Odious, embarrassing’ system driving down health sign-ups.) Since then, Medicaid managers have removed some of the most invasive questions about assets that are necessary only for people applying for Medicaid disability benefits. But Dale wasn’t convinced.
“If you know you don’t qualify, can’t you just waive it?” he asked.
“I wish I could say that to you,” answered Lindy Hinman, chief operating officer for the state’s health exchange,Connect for Health Colorado. “We need to make sure you’re in the right program…so you have to go through the entire financial process.”
“Yeah, and hope it’s hack-proof,” Dale responded.
Another woman asked about the long wait times that some customers are experiencing to get Medicaid approvals or denials. Until customers get a denial, those who want federal tax subsidies cannot buy a plan through Colorado’s exchange. (Click here to read about a woman who finally got to move forward and buy through the exchange after waiting 37 days.)
“I’ve heard stories about how long it’s taking to get Medicaid denials,” said Lola Feher, an advocate for health reform who works for the Colorado Center for Nursing Excellence.
Once again, with no Medicaid manager there, Hinman had to respond. She explained that under the law, Medicaid managers can take 45 days to determine if a person is eligible. Hinman said she’s confident that Medicaid officials are working hard to reduce wait times and speed up the process.
Salazar assured Feher that state officials are aware of delays.
“It has been a problem and we don’t want people stuck at that bottleneck,” Salazar said. “It’s terrible when someone is waiting days and can’t get (problems) fixed.”
Added Hinman: “We are working very closely with our Medicaid partners to make sure that process is as efficient as humanly possible.”
Skepticism from customers may indicate that the botched launch of health reform nationally and the complexity of Colorado’s sign-up system could be turning people off instead of prompting them to buy.
The Greeley meeting was the first of five that Salazar plans to host around the state. She’s planning to hold meetings in resort communities where higher rates are driving away customers. (Click here to read Polis fights sky-high rates as ski town sign-ups stall)
Salazar wants to give people the opportunity to ask questions about health reform, canceled insurance policies, newer, more robust plans offered through the exchange and varying rates across the state.
“It’s not a perfect law,” Salazar said of the Affordable Care Act, also known as Obamacare. “But it’s our chance to make sure people will have access to health insurance so they can get care.
“Don’t give up,” she urged people in the audience, noting that Colorado has a great network of people ready to offer free, impartial assistance. She also said Coloradans are lucky to have so many health insurance carriers competing for their business.
“We’re so fortunate that we have as many plans as we’ve got,” Salazar said.
On Tuesday, only about 11 members of the public showed up. There hadn’t been much advance publicity and the meeting was hard to find.
But the lack of interest in getting questions answered from the top insurance official in Colorado shows that getting people to sign up for health insurance — even when they have 541 choices for new plans in Colorado — has been a tough sell so far.
Stephanie Keener is a coordinator for the health coverage guides in the 18 counties throughout northeastern Colorado. Keener and her team of well-trained, bilingual sign-up guides are beating the bushes for customers. They’re hanging out at grocery stores and libraries where they’re handing out information and offering to meet with people in person as many times as it takes to get them signed up. Still, Keener said it’s been especially tough to interest customers in the far northeastern part of the state.
While interest had been picking up, Keener said President Obama’s reversal last week — when he said people who had received cancellation notices could keep their plans for one more year — put the kibosh on new sign-ups for Colorado navigators.
“Our phones went dead on Friday,” Keener said.
In terms of the Medicaid application, Keener said it has gotten easier to fill out over the last 10 days since managers removed some financial questions.
“The application is flowing much better,” she said, estimating that it’s now taking about 15 to 30 minutes to fill it out instead of the two hours it was taking before.
Many customers still are having to wait — on average about 16 days Keener said — to get a denial from Medicaid so they can move forward.
“About 1 in 3 (customers are getting) a real time denial, which is much better than it was,” Keener said.
Colorado’s Medicaid director, Sue Birch, has contended in health exchange meetings that customers can get real-time denials or approvals for Medicaid as often as 70 percent of the time, while exchange officials have said that they’re hearing it’s closer to 30 to 50 percent of the time.
The denial is crucial because in order to get health coverage by Jan. 1, customers must buy a plan by Dec. 15. Wait times could push people well past that deadline. In order to get any insurance plan for next year, customers must buy by March 31. Those who do not will face financial penalties.
Keener said she’s not hearing any complaints about health plan rates in northern Colorado. Instead the people who are signing up tend to be those with illnesses who either could not qualify for health insurance in the past or were paying very high rates.
“We hear the most gratitude from those who have a preexisting condition. They’re ecstatic. Their premium has gone from $1,200 a month to $200 a month. That’s where we’ve seen the most benefit,” Keener said.
So far, young people aren’t coming in for help, she said.
Keener praised a controversial new campaign launched by the Colorado Consumer Health Initiative and the liberal group, Progress Now, that used a salacious ad about birth control and jokes about drinking games to encourage young people to buy health insurance. (Click here to read Tapping sex and beer to sell insurance.)
Among the health insurance that should appeal to young people are catastrophic plans that are being marketed as CYA plans.
Salazar said her department will reevaluate the state’s pricing regions for 2015 and she said she’s meeting with health insurance executives this week to encourage them to restore canceled plans for any of the 250,000 customers who still want them.
Salazar warned that customers who stick with a canceled plan won’t be getting the same full slate of essential benefits that they would receive in a new health plan. But, she wants to follow through on Obama’s promise to give them an additional year to make the switch.
“It’s not a simple process. The rates would probably go up for those plans,” Salazar said.
That’s because individuals who keep old plans will probably be sicker people. Insurance carriers will then raise rates to cover costs. Salazar is encouraging everyone to shop on the exchange.
“We hope the exchange is going to be very successful,” she said. “To us, the most important thing is that people have coverage on Jan. 1.”
Among the people hoping to buy insurance is Tracy Hume of Greeley. She has temporary insurance through COBRA that costs more than $600 a month.
“It’s insanely expensive,” said Hume, a self-employed freelance writer.
Hume hasn’t shopped yet on Connect for Health and is relatively healthy. She said she’s been waiting for problems to settle, but expects to buy a policy soon.
“I don’t think it would be responsible for a 53-year-old single mother of two teenagers to go without insurance,” she said.
“The COBRA is killing my finances,” she said.
She’s concerned about the time it will take to complete the application and pick a plan.
“I know I’m not going to be eligible for Medicaid. That’s crazy. Why put up hoops for the people who have to support this system? Obviously from the questions in the audience tonight, that’s a barrier. Why would they design it that way?”
© 2013 Health Policy Solutions