Obamacare’s insurance marketplace was supposed to have "no wrong door" — meaning shoppers would be smoothly routed to whatever help they’re qualified to receive, such as Medicaid coverage or tax credits to put toward their purchase.
But it isn’t working as planned in Utah.
Get coveredUnder the Affordable Care Act, nearly all Americans will be required to have health insurance by 2014 or pay a tax penalty. An estimated 359,577 uninsured Utahns will be able to buy insurance online at healthcare.gov starting Oct. 1. Many will qualify for federal subsidies to put toward their purchase — such as a single person earning between $11,000 and $44,000 a year, or a family of four earning between $33,000 and $92,000.
How to shop
Eleven groups are federally certified to help Utahns enroll in coverage.
Bear Lake Community Health Center, Garden City
Carbon Medical Service Association, East Carbon
Community Health Centers, Midvale
Enterprise Valley Medical Clinic, Enterprise
Green River Medical Center, Green River
Midtown Community Health Center, Ogden
Mountainlands Community Health Center, Provo
Southwest Utah Community Health Center, St. George
Utah Navajo Health System, Montezuma Creek
Wasatch Homeless Health Care, Salt Lake City
Wayne Community Health Centers, Bicknell
Consumers will need to find the right door, at least initially, or they will possibly face delays in obtaining coverage, said Kevin Burt, associate director of public aid eligibility at the Department of Workforce Services (DWS). "It’s important that the person apply at the best place for them."
When Utahns fill out a single application at healthcare.gov starting Oct. 1, federal health officials intended to electronically transfer information about candidates for the state’s Medicaid program to state eligibility workers.
"But what we are hearing from [federal officials]," Burt said, "is the functionality to be able to transfer applications to the state will not be ready by October 1."
The contingency plan is for the Centers for Medicare & Medicaid Services (CMS) to screen Utah’s applications and transfer back the applications of those deemed qualified for Medicaid at some later date, Burt said.
"It’s tricky for the consumer because they are left with a pending status," Burt said, "and it’s tricky for our [eligibility workers] because we have to handle a large number of applications all at once."
Mike Fierberg, a regional spokesman for CMS, said that data-transfer systems are being tested. When they might be ready, he couldn’t say.
But he stressed, "there are contingency plans to do those transfers. ... This is not a fatal error."
Utah is ready to accept the data now, said Burt.
Under the Affordable Care Act, almost all Americans must have health insurance coverage in 2014. Starting Oct. 1, uninsured Utahns will be able to go online and shop for a health plan at a federally run "exchange," which is the website at www.healthcare.gov.
Utahns can instead apply now for Medicaid directly with the state at www.jobs.utah.gov. If people are found to be ineligible, state officials will transfer their applications to the federal exchange, starting Oct. 1, to see if they are entitled to tax credits instead.
"CMS says they will be ready to take our referrals, but we haven’t been able to test that feature, which is a little worrisome," said Burt.
And it’s not that simple. Medicaid eligibility rules change Jan. 1, so if you aren’t entitled under the current rules, Utah may hold on to your application anyway and screen it again in January.
Some consumers may opt to wait until all systems are go.
But doing so risks missing the open-enrollment period for buying insurance, from Oct. 1 to March 31. It takes an average of 21 days to screen someone for Medicaid.
You could hedge your bets by applying on both websites.
"Individuals will have to answer the same questions twice," said DWS spokesman Nic Dunn. "But there isn’t any kind of penalty for doing that."
Perhaps a better strategy, he said, would be to seek counsel from federally certified navigators and application counselors.Next Page >
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