Special enrollment & the Affordable Care Act

For a large segment of the US general public, open enrollment for health care coverage through the Affordable Care Act (ACA) in 2014 was October 1, 2013 through March 31, 2014. Most who missed that window will have to wait until the next open enrollment period for coverage in 2015, which is November 15, 2014 through February 15, 2015. However, exceptions for certain life events qualify some people for special enrollment, which is year round. Exceptions include those who qualify for or are renewing Washington Apple Health (formerly known as Medicaid in Washington state), marriage, divorce, birth or adoption of a child, foster care, or death of a dependent. There are many other qualifying factors, but all of the explanatory jargon can be confusing at times.Health Care 1985

Thankfully, our Family Assistance Program has been hard at work providing trainings and legal advice on the ACA. The purpose of these trainings is to assist people with education on and enrollment in the newly available medical insurance through the Health Benefit Exchange and Apple Health. For example, one of the major changes from the expansion of the Medicaid program affects those making up to 138% of the Federal Poverty Level. Specifically, if a single household earns under $1,274 per month (or $15,290 per year), then they can access Apple Health and apply for it at any time. Folks who make more than that are potentially eligible to purchase a Qualified Health Plan through the Health Benefit Exchange during the next open enrollment.

Solid Ground holds an ongoing commitment to educate and enroll the uninsured in free or affordable health care. From October 1, 2013 to May 29, 2014, 178,659 residents were enrolled for health care coverage in King County. Amazingly, 40,021 of them were previously eligible for Medicaid but not enrolled, 48,344 are receiving coverage through a Qualified Health Plan, and 90,294 newly eligible people signed up for Apple Health. Our President and CEO, Gordon McHenry Jr., couldn’t be more thrilled. “These impressive results were the work of a great partnership involving King County Public Health, our medical providers and many nonprofits, including Solid Ground,” he said in a letter to Solid Ground staff. “Equitable access to quality, free or affordable health care is essential to a community that is healthy and thriving.”

Reminder: Open enrollment for Apple Health is year-round, and applications can be accessed through Washington Healthplanfinder. If you have questions regarding special enrollment or anything else regarding coverage under the ACA, please contact the Family Assistance Program at 206.694.6742.

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Affordable Care Act: Help us continue to get the word out!

Image from U.S. Dept. of Health and Human Services study - HealthCare.gov

U.S. Dept. of Health and Human Services study – HealthCare.gov

King County is a national leader in obtaining health care coverage through expanded Medicaid and Qualified Health Plans. In 2013, King County set a goal of enrolling at least 180,000 residents (80,000 in Medicaid and 100,000 in subsidized Exchange coverage) by 31 March 2014, the end of the initial enrollment period.

On Friday, we convened the Executive Committee of the King County Enrollment Leadership Circle to review our progress. I’m pleased to report that by early this month, over 75,000 King County residents have been enrolled since October! Our challenge is that of those 75,000 new enrollees, only around 20,000 are enrolled in a Qualified (subsidized) Health Plan. Also, those enrolled between the ages of 19 and 34 are significantly low.

While King County is on-plan to achieve its goal of enrolling 80,000 persons in (expanding) Washington Apple Health (Medicaid), we need significant renewed effort to reach our goal of ensuring 100,000 eligible residents obtain affordable care through a Qualified Health Plan.

Solid Ground will remain a leader as a part of King County’s collective effort to leverage this historic opportunity (see The Affordable Care Act: A potential ‘life-changer’ for people living on low incomes). As we know well, education, employment and health care are essential to ending poverty.

That is whywe are encouraging everyone to talk with family, friends, colleagues and clients, especially those who are ages 19 – 34. Please initiate conversations regarding health care and encourage those who do not have coverage to enroll prior to 31 March 2014. Thank you!

The Affordable Care Act: A potential ‘life-changer’ for people living on low incomes

King County "Coverage is Here" logoIn partnership with King County Public Health, Solid Ground’s Family Assistance program has been engaged in outreach and education on the Affordable Care Act (ACA) since open enrollment began October 1. As the December 23 enrollment deadline to receive benefits starting January 1 approaches, it becomes more important than ever to reach out to King County residents.

Despite the well-reported problems with the federal website, HealthCare.gov, Washington State’s exchange site, wahealthplanfinder.org, has had relative success enrolling people, though not without its own challenges. While the state exchange site has had its hiccups, it is still performing better than the national federal enrollment website. As of December 3, wahealthplanfinder.org enrollment topped 175,000 while the federal exchange, which serves 36 states, enrolled about the same.

Stephanie Earhart, Family Assistance Lead Benefits Attorney, is managing Solid Ground’s Education and Outreach program for the ACA. According to her, both the federal and state website glitches are causing the most issues with enrollment.

“The problem with wahealthplanfinder.org is rooted in the fact that, in order to confirm an identity, a cross-check must be performed through the HealthCare.gov website – which also hooks up to the IRS, Social Security and immigration sites. If anything goes wrong with those hubs, we get an error code on our end. People enrolling will then be told to call the customer center, but those centers are overloaded with calls,” Stephanie explains.

Another option is to file a paper application. However, paper applications must still be entered into the same system, and thus will experience the same glitches consumers are struggling with. Stephanie mentions that in November, “only 17% of those on existing Medicaid plans had renewed them – likely because those renewals were filed as paper applications. There is a backlog now, and who knows when those will get processed.”

Instead, she encourages King County residents to use the Washington exchange website if possible or find an assistor to help set up an account and work through any issues that might arise.

Neighborcare Health has partnered with Solid Ground, acting as in-person assistors for those needing help with enrollment and navigating the website. A Neighborcare assistor provides enrollment support at Solid Ground every Tuesday between 1-5pm, or you can call 206.548.3013 to schedule a free appointment with an eligibility specialist at a local Neighborcare Health clinic.

One of the Education and Outreach program’s most important goals is to end confusion about ACA and the benefits offered – which is still causing people to hesitate to enroll. “I still talk to clients who have no idea about the Affordable Care Act, or what they have heard is bad. As an agency, that’s one of the reasons Solid Ground is supporting education and outreach. We want people to know that this is actually a good thing. We support it. You can trust it,” Stephanie expresses. She recommends the King County Public Health website as a great resource for more information on all the wonderful benefits – such as the 10 Essential Benefits – Affordable Care coverage has to offer.

We are spreading the message to clients, friends and family: ‘Coverage is here!’ To Stephanie – and many others at Solid Ground who work directly with people who qualify for the new free or low-cost health insurance – the implementation of the ACA is a blessing. Stephanie declares that, “Coming from the work I’ve done for the last 10 years, fighting to get people medical coverage – very sick people who don’t meet the disability standard – the fact that I can say, ‘You can get covered now,’ that’s my focus. For those living on low incomes, this is going to be a life-changer. True social justice.”

If you would like us to visit your community organization to do an education/outreach event, please contact Stephanie Earhart with the Family Assistance program: stephaniee@solid-ground.org or 206.694.6714.

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