Thursday, May 29, 2014

Eligibility verification not complete for nearly 5,000 private option beneficiaries; coverage will end May 31 until process is complete

Posted By on Thu, May 29, 2014 at 6:27 PM

A technical glitch led to 4,798 Arkansans gaining private option coverage prior to fully completing the eligibility verification process. The error was rooted in the way that the federal government submitted data from healthcare.gov to the state. These people have received letters from the Department of Human Services indicating that their private option coverage will end on May 31; in order to regain coverage, they must go back to healthcare.gov and complete the application process. 

Many of these folks will likely end up qualifying for the private option — if so, they will receive retroactive Medicaid coverage and will not have a gap in coverage. But some may in fact make too much to qualify for the private option, in which case they will be able to purchase insurance on the Arkansas health Insurance Marketplace (if they make less than 400 percent of the federal poverty level, they'll get subsidies to help them with the cost of insurance). The loss of private option coverage would count as a qualifying life event, so people would be able to sign up even though the open enrollment period is over. According to DHS spokesperson Amy Webb, the feds have stated that people in this situation will be able to get same-day coverage if they pay their first month's premium (though this sounds to me like a pretty optimistic hope for the efficiency of healthcare.gov!). 

How did this happen? There were a variety of ways to apply to the private option this year, including a state-run website that operated smoothly. It was also possible to sign up through healthcare.gov — the federally facilitated website used for the Arkansas Marketplace and for more than 30 other state marketplaces across the country. When someone applied on healthcare.gov, the feds verified income and passed on two types of data files to DHS — those that were determined eligible for the private option and those whose eligibility verification was still pending (typically because some piece of additional information was still needed). At some point, the feds began to include some of the "pending verification" files in the batch that state officials believed were "determined eligible" files. The mix-up has now been resolved, but in the interim, nearly 5,000 were enrolled in private option coverage prior to the completion of the verification process. 

"This is a huge new program, it's new IT systems, there are going to be mistakes," Webb said. "What this shows is that we're watching and when we find that there's an error, we're going to make sure it gets fixed." 

For the 4,798 who received letters — theoretically, this can be resolved with minimal or no gaps in coverage. But frankly, it sounds like it's going to be a massively confusing hassle for anyone caught in this situation. DHS is instructing them to go to healthcare.gov to finish the verification process. But completing the process right now won't necessarily work, since the site is likely going to show them as already having coverage. Webb said that federal and state officials are working to resolve that issue now. By June 1, when their current private option coverage ends, that hiccup will be no longer be a problem, but presumably many will be aiming to resolve the problem immediately, prior to their coverage ending. Some folks, understandably fed up with healthcare.gov, might try to start over on Access Arkansas, the state-run website, but prior to June 1, they could run into precisely the same confusion — the site would say they were already covered. And Access Arkansas will ultimately only work for people eligible for the private option. Even in a best-case scenario, those who received letters may be stuck with days or weeks of uncertainty, and resolving the matter is likely to be at least a headache. All of that's not to mention the fact that likely at least some people who make too much to qualify nevertheless gained federally funded private option coverage, albeit only for a matter of months. 

The whole thing, in short, is probably manageable, but still a mess for those involved — and ultimately sorting it out is largely going to happen on healthcare.gov, precisely where the confusion began! Those opposed to the private option and/or Obamacare will no doubt blow this out of proportion for partisan talking points, but let's not forget that screwups like this by the feds have real human costs. 

DHS press release after the jump. 

For Immediate Release:
May 29, 2014


DHS Sending Notices to Some Health Care Independence Program Clients
The Arkansas Department of Human Services (DHS) is notifying 4,798 individuals that their Health Care Independence Program/Private Option coverage will end effective May 31 because the federal government incorrectly included their information among applications of eligible individuals.

While reviewing application information from the federal government, DHS Division of County Operations (DCO) staff noticed missing information and income levels that would exclude people from Health Care Independence Program coverage.

After questions were raised by DCO staff, the federal government notified us that the state had been sent data for people whose applications were “pending verification.” Arkansas should only receive applications for people who have been determined eligible and that have been fully verified.

To ensure only eligible individuals are enrolled, DCO sent out the above-mentioned notification letters.

“We regret that people are in this position and may be confused by the letters,” said Amy Webb, DHS Communications Director. “Arkansas acted in good faith after receiving initial notification of eligibility from the federal government, but it appears those notifications were premature.”

Some of the people who received letters may, in fact, be eligible, but must go to www.healthcare.gov and provide any information needed to complete the verification process. Others may instead be eligible for coverage through the
Federally Facilitated Marketplace and should return to www.healthcare.gov. Loss of Health Care Independence Program coverage is a qualifying event that will allow people to return to www.healthcare.gov even though the open enrollment period has ended. Individuals who complete the application process and are determined eligible for the Health Care Independence Program will receive retroactive Medicaid coverage and, therefore, will not have a gap in services.

If people have questions about their coverage, they should call 1-855-372-1084 or visit a local county office. 

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