Fixes to Kansas insurance marketplace produce trickle of activity

Medicaid gap and adequacy of navigator screening process continue to be issues weeks after Obamacare marketplace launch

0 | Health Reform, Insurance

Paige Ashley, a certified navigator with the Shawnee County Health Agency, helps Lover Chancler, of Topeka, sign on to the Kansas marketplace at recent consumer education session at the Topeka Shawnee County Public Library.

Paige Ashley, a certified navigator with the Shawnee County Health Agency, helps Lover Chancler, of Topeka, sign on to the Kansas marketplace at recent consumer education session at the Topeka Shawnee County Public Library.

CORRECTION APPENDED

TOPEKA - The technical problems that have plagued the federal online health insurance marketplace since its launch three weeks ago are slowly being resolved, at least in Kansas, according to those who are helping people navigate the new system or are using it to sell health plans.

“We have received transactions from the marketplace and have been working to verify information and setup memberships,” confirmed Mary Beth Chambers, a spokesperson for Blue Cross Blue Shield of Kansas, one of the companies offering plans on the exchange.

Chambers said Kansans who purchase coverage on the marketplace will be included in the company’s regular monthly enrollment update report. But she said consumers who sign up for coverage on the marketplace between now and the Dec. 15 deadline won’t be included in the update until after the first of the year when their coverage becomes effective.

And there are factors besides the technical hurdles that are complicating efforts to enroll uninsured Kansans in the private coverage offered on the Obamacare marketplace.

For one, several consumers who have completed the enrollment process with the help of specially trained navigators have learned they are too poor to qualify for federal subsidies and so cannot afford to buy the coverage. Kansas’ Republican leaders have chosen against expanding the state’s Medicaid program to allow more people access to the subsidies, leaving an estimated 58,000 to 78,000 Kansans in the so-called Medicaid gap.

And officials overseeing the recruitment and training of navigators said they fear that continuing controversy about whether the navigators are being adequately screened could hinder efforts to get more of the helpers in the field.

Debugging the marketplace

Federal officials apparently have made progress in fixing the technical problems that rendered the marketplace virtually inoperable in Kansas and the 35 other states that opted not to design and operate their own exchanges. But that progress has been slow.

According to a weekly report from the National Association of Medicaid Directors, states' interconnectivity with the federal marketplace hub was generally improving but a host of other problems continued.

Officials overseeing a Kansas navigator program said reports from the field at the end of last week indicated that only five consumers had completed the enrollment process, though there likely were more than that. Federal officials still aren't releasing enrollment figures.

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Cathy Harding, executive director of the Kansas Association for the Medically Underserved.

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“Those are small numbers, but it’s progress,” said Cathy Harding, chief executive of the Kansas Association for the Medically Underserved, the lead organization in a consortium of nonprofit groups helping to train and deploy navigators.

Consumers still struggling to navigate the federal marketplace website can now use the Kansas Insurance Department’s website site to help determine the plans available to them and their costs.

Linda Sheppard, director of health care policy at the department, said people can’t buy coverage on the department’s site but that new features allow them to see a list of plans available in their area and to compare rates.

“So, hopefully it will give them a little bit of a head start,” she said.

Nearly 190,000 uninsured Kansans are expected to purchase private coverage through the marketplace, according to an analysis by the Kansas Health Institute, the parent organization of the KHI News Service.

Falling into the “coverage gap”

Navigators with the KAMU consortium said they helped three people who did the enrollment screening only to learn they couldn’t afford any of the coverage because they were too poor to qualify for federal subsidies.

“We’re getting people all the way through the process only to find out that they fall into the Medicaid gap,” Harding said.

In Kansas, adults with children are eligible for Medicaid (known as KanCare) only if they earn less than 32 percent of the federal poverty level — $7,421 for a family of three. Childless adults are not eligible regardless of income.

Eligibility for federal tax credits starts at 100 percent of federal poverty guidelines or $19,500 for a family of three.

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Paige Ashley, a certified navigator at the Shawnee County Health Agency, helps consumers sign on to the Kansas health insurance marketplace at the Topeka Shawnee County Public Library.

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Paige Ashley, a navigator with the Shawnee County Health Agency, said that based on the calls she has already received, she expects that many of the people who come to her for help will fall into the gap.

“Most of the phone calls I’ve received are from people who don’t have insurance but who have health issues,” Ashley said. “Unfortunately, many of them aren’t working and they’re upset to find out that they don’t get any of the tax credits. They kind of fall through the cracks since we didn’t expand Medicaid.”

James Letcher of Lawrence said he worried he will be one of those who falls through the cracks.

He lost his job and his insurance last winter and isn’t sure whether he’ll have enough income to qualify for a federal subsidy. Without it, he said, he can’t afford coverage.

“It’s going to be really close,” he said. “I’m just praying I can get another job.”

Kansas officials could have closed the coverage gap by expanding KanCare eligibility to 138 percent of federal poverty guidelines – $15,900 for a family of three. But Gov. Sam Brownback, a Republican, and the Republican-dominated Legislature so far have chosen not to expand the program despite a provision in the health reform law that obligates the federal government to fully fund the expansion for three years.

Several organizations led by the Kansas Health Consumer Coalition and the Kansas Hospital Association are expected to again push for Medicaid expansion in the 2014 legislative session.

Navigator controversy continues

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Rosilyn Wells

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Last week, the Daily Caller, a conservative news and opinion website, reported that Rosilyn Wells, an outreach worker at the Heartland Community Health Center in Lawrence awaiting certification as a navigator, had an outstanding arrest warrant due to her failure to pay more than $5,000 in medical debts.

The report questioned whether the organizations overseeing the recruitment and training of navigators were doing an adequate job screening applicants.

A second story later in the week reported that Veronica Miranda, a navigator working in the Wichita area, had participated in a June protest at the home of Kansas Secretary of State Kris Kobach.

Kobach, a Republican, is a controversial figure in Kansas and nationally because of his advocacy for what some see as extreme measures to prevent illegal immigration and voter fraud.

“It is shocking that the Obama administration has hired as a navigator a person who has been caught trespassing and attempting to intimidate a federal official,” Kobach said in the Caller report.

Harding took issue with Kobach’s characterization of the event.

“It was a peaceful protest,” she said. “No one was found guilty of any wrongdoing.”

Harding said criminal background checks are performed on all prospective navigators but that it would be inappropriate to ask about their political views as part of the job screening.

“Of course, we don’t do that,” she said. “We can’t do that.”

Members of the consortium are hoping to deploy 250 navigators across the state by the end of the year, Harding said. More than 220 of those are either in training or already in the field.

Harding said the Daily Caller stories were “much ado about nothing,” and that the consortium had “more-than-adequate” screening procedures in place.

At least one influential Kansas legislator doesn’t agree.

Sen. Mary Pilcher-Cook, a Shawnee Republican who chairs the Senate Public Health and Welfare Committee, said she intends to pursue legislation in the 2014 session to further regulate and license navigators. She said the current screening process “failed to protect” Kansas consumers.

Meanwhile, Harding said she was concerned the additional scrutiny could hamper efforts to recruit navigators.

“It’s too early to tell what kind of impact it might have,” she said. “But, of course, I’m concerned about it.”

CORRECTION: An earlier version of this story incorrectly described when Blue Cross Blue Shield of Kansas will report the number of enrollees in their marketplace plans.

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KHI News Service coverage of Medicaid expansion

Medicaid Access Coalition launches online "ticker" showing foregone federal dollars (2/13/14)
→ KHI report: Nearly 182,000 Kansans in the ‘Eligibility Gap’ (1/11/14)
House speaker says Medicaid expansion is "up to the governor" (1/10/14)
KS Senate president says Medicaid expansion unlikely to gain approval this session (1/7/14)
Profiles of the coverage gap: Kathleen Christian (1/6/14)
Efforts continue to expand Medicaid in Kansas and Missouri (1/6/14)
Hospital association hires former Bush HHS secretary to help craft a plan Kansas Republicans might support (12/23/13)
Iowa wins approval to expand Medicaid by using federal funds to buy private insurance (12/11/13)
White House officials hold call to urge Medicaid expansion in Kansas (11/21/13)
Republican governor talks up plan to expand Medicaid — his way (10/28/13)
Challenger says Brownback owes voters a decision on Medicaid expansion (10/22/13)
Nearly 5.2M Americans fall in coverage gap in states not expanding Medicaid (10/16/13)
Sebelius: Feds flexible on how states expand Medicaid (9/22/13)
Sebelius says Kansas and Missouri are missing the boat on Medicaid expansion (9/20/13)
Medicaid expansion coalition finds strength in numbers (9/17/13)
Republican Gov. Corbett proposes expanding Pennsylvania Medicaid (9/16/13)
Kansas lawmakers urged to consider Medicaid expansion by Wesley CEO (8/29/13)
Estimating maneuver could help more people gain from Obamacare: How the poor might qualify for Affordable Care Act subsidies in states that don't expand Medicaid (8/12/13)
Report: States not expanding Medicaid stand to benefit most from doing so (7/18/13)
CMS won’t penalize hospitals in states slow to expand Medicaid (5/14/13)
Insurer Centene: We can do Arkansas-style Medicaid (5/14/13)
The Arkansas Medicaid Model: What you need to know about the 'private option' (5/2/13)
Nothing to be done about coverage gap in states not expanding Medicaid, feds say (4/29/13)
Brownback says he's listening to Medicaid expansion proponents, opponents (4/5/13)
Oregon shows costs of putting Medicaid enrollees in private coverage (3/29/13)
Governor urged to expand Medicaid eligibility (3/27/13)
Arkansas Medicaid expansion attracts other states' interest (3/26/13)
Senate president prefers options remain open on Medicaid expansion (3/25/13)
States urged to expand Medicaid with private insurance (3/22/13)
Senate budget amendment underscores opposition to Medicaid expansion (3/21/13)
Study: Kansas employers face millions a year in possible penalties without Medicaid expansion (3/15/13)
More than 30 Kansas groups pushing for Medicaid expansion (3/12/13)
Health insurers see big opportunities in health law’s Medicaid expansion (3/8/13)
Medicaid expansion supporters to step up lobbying efforts (3/7/13)
Budget committee hears resolution opposing Medicaid expansion (2/22/13)
Legislators focusing on Medicaid expansion cost estimates (2/19/13)
Kansas hospital group study predicts expanding Medicaid would generate 4,000 jobs (2/18/13)
Brownback officials release their cost projections for Medicaid expansion (2/8/13)
Medicaid expansion bill introduced (1/22/13)
Kansas hospitals worried about loss of dollars for charity care (1/14/13)
Brownback compiling own estimate of Medicaid expansion cost (12/20/12)
Group urges Brownback to expand Medicaid eligibility (11/9/12)
Debate begins on possible Kansas Medicaid expansion (10/25/12)
Amerigroup CEO says states ‘need’ to go along with Medicaid expansion (7/11/12)
Kansas hospitals ready to get on with federal health reform, spokesman says (7/2/12)
Kansas AG claims partial victory in health reform case (6/29/12)
High court upholds Affordable Care Act, but ruling puts limits on Medicaid expansion (6/28/12)

Commentary
→ Kansas Hospital Association: An opportunity for the Kansas Medicaid program
→ Americans for Prosperity-Kansas: Well-intentioned policies do more harm than good
→ Health Reform Resource Project: The cost of not expanding Medicaid
→ Rep. Jim Ward: Medicaid expansion essential for healthier Kansas
→ Rep. David Crum: Reasons for opposing Medicaid expansion
→ National Academy for State Health Policy: Much ado about Arkansas: Medicaid in the insurance exchange

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