Maddened over missing details on Medicaid coverage


Enrollment delays: They’re not just for consumers who sign up for private insurance.

Although there’s plenty of focus on sign-up snafus for people buying coverage through the state exchange’s Nevada Health Link, there’s less attention on enrollment hitches through Medicaid, the state-run program for lower earners.

The Affordable Care Act has expanded the number of adults eligible for Medicaid, but patients tell us they can’t get details on coverage they signed up for weeks ago:

■ Las Vegan Vickie Dority writes: “My daughter and I put in our required application for Medicaid insurance on Dec. 12, and still haven’t received any coverage. I have had to cancel all blood work and doctor appointments for my hypertension.”

So Vickie, we forwarded your email to the state Welfare and Supportive Services Division, which handles Medicaid applications. The issue: They couldn’t find your original application. Now, they’re working with you one-on-one to help you and your daughter fill out new paperwork.

That’s one case solved. But here’s a quick primer on what all Medicaid applicants need to know.

First, Vickie’s problem isn’t that unusual. Between electronic glitches that have kept Medicaid applications from making it through Nevada Health Link to confusion about when a consumer is actually enrolled, it’s “very common” for Medicaid paperwork to get lost in the ether, said Rachelle Church, a welfare division social services manager.

The exchange pushed through to the welfare division in January a three-month backlog of 17,000 Medicaid applications stuck in the system since October, Church said. For the most part, the technical problem that prevented applications from forwarding is fixed, but some coverage requests still aren’t getting through.

What’s more, some who sign up through Nevada Health Link assume they’re enrolled in Medicaid when the website tells them they’re eligible, Church said. That’s not the case. Two additional steps are needed. That’s why Church recommends consumers log back into Nevada Health Link to double-check that their application is complete.

Then there are the sheer numbers the division is dealing with. Exact volume won’t be known until March 15, but Church said caseworkers are fielding eight times more applications for all types of aid each month than they received before October. Employees are working weekends to get through the applications, but it’ll be months before they’re caught up, she said.

To add to the problem, it’s difficult to reach a live person to check an application’s status, insurance brokers say.

Lydia Boske, a broker with Nevada West Business Insurance and president of the Clark County Association of Health Underwriters, said the welfare division was referring questions to Nevada Health Link, which would send them back to the division. Nevada Health Link in November published a list of seven agencies that could help with Medicaid enrollment, but only one could help healthy, childless adults in Las Vegas enroll. It’s in Reno, so walk-ins are difficult.

Nor does Nevada Health Link’s call-center message cite Medicaid enrollment as an option for callers. The system does refer to applying for public assistance for food and energy bills, but that’s confusing to consumers listening for Medicaid, Boske said. And forget calling the welfare division. Boske has worked with consumers who report waiting up to three hours to get through, only to have their call dropped because of high phone-in volumes.

Here’s Boske’s advice: If you’re healthy and you’re applying for Medicaid just to have coverage, submit your paperwork and be patient. It’ll take a while, but your cards will come eventually. If you end up needing care, you’re good, because Medicaid will pay for care as far back as 90 days before your application date.

If you’re ill and you need care now, visit the welfare division’s offices at 611 N. Nellis Blvd. or at 2505 Chandler Ave. You may have to wait half a day to see a caseworker, but if you qualify you can leave the office with Medicaid card in hand.

“The bottom line is, we’re all trying to help consumers navigate this system,” said Boske, who makes no commission for helping Medicaid enrollees. “Let’s fix this before it becomes a public outcry, and I believe it will. We have people who have enrolled who are trying to fill prescriptions, but they never got their cards.”

■ Back on the exchange, Gary (last name withheld) thinks his subsidy as calculated by Nevada Health Link is a little off: “According to the website, I am eligible for a $150 subsidy toward health insurance. Even given this subsidy, the least-costly plan will still cost $275. I was told by a representative whatever the website said is what the subsidy will be. This $150 subsidy does not seem right to me. Can you help?”

We ran your details through a couple of subsidy calculators, Gary, and we don’t think your subsidy sounds right, either.

Based on the personal information you gave us — 62 and single, make $15,996 a year, have never smoked and live in Clark County — it looks as if you should be paying a lot less. Subsidy calculators at the Kaiser Family Foundation and ValuePenguin.com each say your cheapest plan should cost you less than $50 a month.

ValuePenguin.com quoted a MyHPN Silver 4 plan at a monthly premium of $42.25. That’s with a $533.09 premium, and a $490.83 subsidy. The most you should pay for a silver plan would be $200.12, and that would be for Blue Cross and Blue Shield’s Silver Direct Access, which has a monthly premium of $690.96 and a subsidy of $490.83.

Kaiser’s calculator said your annual presubsidy premium would be $6,429, but that your tax credit should cover 92 percent of the cost, or $5,891. That would leave you on the hook for $539 a year, or about $45 per month.

We ran your situation by CJ Bawden, a spokesman for the Silver State Health Insurance Exchange. His first question was whether you receive nontaxable Social Security income. If you do, that income is added back into your modified adjusted gross income calculation, and could affect your subsidy. If that’s not the case, Gary, try logging back into your account and submitting a new application. You may have made a typing error or entered a deduction incorrectly.

For a second opinion, plus some help redoing your application, reach out to a navigator firm or an insurance broker. Navigator groups include the Ramirez Group, the Consumer Assistance and Resource Enterprise and the Latin Chamber of Commerce Community Foundation. The state has also certified about 1,500 health insurance brokers to sell exchange coverage.

 

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