Here’s another HealthCare.gov problem – and a workaround – that haven’t gotten much attention.
People can apply for Medicaid (traditional or expanded) via the federal HealthCare.gov website. But the applications still have to get transferred to the states which have to process them to finalize enrollment in the actual state program. And it’s supposed to be done by Jan. 1.
Guess what? That was a problem. With all the website woes, the feds weren’t able to process that information and had pushed back deadlines. Then, quietly, on the Friday of Thanksgiving weekend, CMS offered a transitional “administrative” fix through this federal policy guidance.
The states are allowed to use the minimal information on the so-called “flat files” to finalize the Medicaid status. The flat files had been pretty bare bones but CMS says expanded files will “include data elements such as: date of birth, Social Security number, eligibility category used for assessment or determination, and verification inconsistencies. The file will identify individuals who have been assessed or determined eligible for Medicaid and CHIP on the basis of modified adjusted gross income (MAGI).”
It would be good to check in with your state’s Medicaid director. Is this enough? Too little, too late? Will people be correctly enrolled in Medicaid by Jan. 1 – or will some be left uncovered, even if they did their part of the application process correctly?
Here’s a list of state Medicaid directors from the National Association of Medicaid Directors.
You have all probably gotten some emails about this website or that app that can give costs of various health plans in the new insurance exchanges. I’ve seen some that list plans county by county. People may be tempted by these easy tools because, on the surface, they look like a way around that pesky HealthCare.gov or some of the balkier state exchanges.
But there’s a problem. (There’s also a solution that I’ll get to, but keep reading.) The information on most of these plans is very general. And it’s “sticker” prices. Some don’t take into account the subsidies or other particular family circumstances. And that sticker price may produce enough “sticker shock” that people are scared off and don’t find out what they would actually pay, particularly if they are eligible for subsidies. Some of the calculators don’t include age, either, and that does affect what people will pay.
Nor do the calculators always produce the same estimated cost. I tried two different ones using the same information about a family I had spoken to in California. I got very different results – thousands of dollars different. Neither was close to what the family found when they did get on the California exchange. (In this case, the family’s costs did go up.)
The Arizona Republic did a consumer-focused story about the calculators in which they urged consumers to get on the real sites (which are – slowly – improving) and find out what the precise costs are for their unique family circumstances. Continue reading
Michael Hiltzik (@hiltzikm) of the Los Angeles Times has done some fine reporting about the bottom line on the health insurance cancellations.
In this piece, he reminds us that, until this wave of headlines about people losing their beloved individual health policies, people hated their individual health policies. Prices rose every year, benefits were skimpier than employer-sponsored coverage, there were lots of out-of-pocket costs, people got dropped from plans – and people who had pre-existing conditions couldn’t get plans.
“It’s time to retire the threadbare meme that the cancellation notices are depriving people of something they love, as though their health plans are as much as part of the family as the dog,” he wrote in what may be my single favorite sentence in a health care story of the past few weeks. Continue reading
The federal government plans to release exchange enrollment figures once a month (here’s the first report), and they’re expected to give more demographic information (i.e. age, metal tier) in future updates. States have different timetables for releasing their statistics. To keep track of it all, the Kaiser Family Foundation has a new tool: the State Marketplace Statistics.
It has both the enrollment numbers as well as some other key stats to watch (when available):
- Completed applications
- Eligibility determinations, including how many people can enroll in a marketplace plan with financial assistance and how many qualify for Medicaid/CHIP
- How many have selected a plan
A few weeks into the cancellation crisis – some of which could be mitigated by the delay President Obama just announced – here’s what we know and what we don’t. In an upcoming post, I’ll highlight two very good stories exploring aspects of this.
The estimates on how many people are affected by plan cancellations vary widely. We’ve seen anything from “hundreds of thousands,” which is too low, to “up to 14 million,” which is too high. Continue reading
I’m not particularly tech savvy but, one month into the HealthCare.gov website mess, here’s some of what I think we do know now – and what we are still waiting to find out.
Traffic: Volume was high, and it was one reason for the system’s poor performance. But it was not the only reason, not by any means. Nor have I seen a convincing explanation for why the administration low-balled the traffic expectations.
Code: There are millions of lines of it and it’s a mess. It’s being rewritten/worked-around. We don’t know much more than that. Continue reading
With all the website woes, you are going to hear a lot more about “delaying” the Affordable Care Act.
But what “delay” means is in the eye of the beholder – or maybe in the political affiliation of the beholder. It’s helpful to think about “delaying” the whole law or the mandate (mostly but not only a Republican idea) versus “extending” the enrollment period – but keeping the mandate in force for 2014, although it could be even weaker than it already is for the first year. That’s an idea that we’re beginning to hear from more Democrats – including several senators up for re-election in red states in 2014. Continue reading
Six years ago, a clinic in Oregon made the decision to ban representatives from the pharmaceutical companies. The doctors and staff say goodbye to free samples of expensive drugs, lavish lunches, pens, notebooks, mugs, toys for children and other “benefits.”
Markian Hawryluk, a health reporter with The Bend (Ore.) Bulletin, picked up on a recent journal article about the transformation and used that as his inspiration to write about how the clinic made its decision and how it changed the way doctors there practice medicine, as well as how the move impacted the community.
As data is collected under the Physician Payments Sunshine Act, a part of the Affordable Care Act that will require pharmaceutical companies to disclose the money and gifts given to physicians, reporters may start noting similar changes in their area.
Read more about how Hawryluk reported the story and what he learned about the influence drug reps and samples have on prescribing.
As one of my colleagues emailed me the other day: “Life’s a glitch.”
We know we’ll be hearing A LOT more about the health care marketplace glitches, including testimony at some upcoming Congressional hearings.
I have not read every article that has come out about the technical problems but here are some that I think are particularly useful right now; there are going to be a lot of developments in this story so whatever I write now will soon be outdated soon.
The Wall Street Journal, on Friday, had what is probably the most detailed description (in plain English) about what the “glitch” is. Continue reading
The other day we gave you a Twitter list of many of the state-based health insurance reforms (courtesy of Huffington Post’s Jeff Young), and here (hat tip for Phil Galewitz) we’ve got a complete list of the exchange websites and call center numbers.
It was compiled by State Reform (a project of Robert Wood Johnson Foundation and the National Academy of State Health Policy). It also has a handy reference of which are state, federal or partnership exchanges.