When consumers apply for insurance they put their income information into subsidy calculators on HealthCare.gov the Affordable Care Act exchange which handles insurance sales for 36 states [including Louisiana].This is how they know what subsidies they are eligible for or whether they qualify for Medicaid.
When the Medicaid assessment is wrong, consumers should file an appeal with the federal marketplace, says Department of Health and Human Services spokeswoman Joanne Peters, but does not know how long this could take.
Jessica Waltman, top lobbyist for the National Association of Health Underwriters, says she's heard a number of reports from around the country of people making as much as $80,000 a year qualifying for Medicaid.
"I have heard on multiple occasions from brokers in various states over the past eight weeks that they have had wacky Medicaid determinations with people who clearly make way too much money for Medicaid," she says.
HealthCare.gov is "working smoothly for the vast majority of users," says Peters, though some people may face issues with taxes or when the family is complicated.
HHS has employed added personnel to help, said Waltman, though when people call the toll free number they are told they are eligible if the site says they are, "It's a very, very unfortunate state of affairs," says Waltman.
"Claims from some states about our process for testing the Medicaid eligibility and enrollment systems are inaccurate," says Peters. "We are eager to work with states to ensure their systems are functioning properly and to extend Medicaid coverage to those who are eligible through the generous Medicaid funding made possible by the Affordable Care Act."
HHS is working "extremely hard" to make sure people will have coverage no matter what on Jan. 1, says Salo. While states support that goal, "some want more assurances that people enrolled in Medicaid are actually eligible," he says.
Jacob Hawkins of Plano, Texas, makes about $50,000 a year as a self-employed pool builder, yet his family of three was seen as eligible for Medicaid. His wife is due to have their second child in February and is worried she won't have insurance in time."I'm frustrated, mad and there's no one to help," says Hawkins.
"What am I supposed to do with the clients that are being told they qualify for Medicaid when they actually do not?" asks Wishner, who owns The Health Insurance Shoppe, a retail insurance store. "Send in an appeal with 16 days left?"
With this much uncertainty, "it's frustrating that there is no place for a broker to get help with errant cases and tries to avert problems," says Waltman.
State exchanges and insurance companies have dedicated customer service support for insurance agents and brokers who try to correct problems "before they escalate," says Waltman.
The Healthcare.gov website has been inundated with programming flaws and various problems since it went online on Oct. 1. It was practically offline most of November as the Obama administration hired technical expertise to repair the defects.
Hannah Punitha (IRDA Licence Number: 2710062)
Jayne O'Donell, Dec 2013