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Medicaid enrollers to face challenges

FLATWOODS, W.Va. -- Enrolling West Virginia's 300,000 uninsured residents in Medicaid or a health insurance plan will be a daunting task that requires a total effort of various agencies in the state, health-care advocates and officials said Tuesday.

"We need all hands on deck," said Perry Bryant, executive director of West Virginians for Affordable Health Care.

To that end, Bryant's group held a training conference Tuesday that brought together about 250 representatives from the state's community health centers, family resource networks, hospitals and free clinics and other agencies to learn the basics of enrollment.

The daylong training conference was at the Days Hotel in Flatwoods.

"I was really pleased with the number of people here, and I'm even more pleased with the diversity of people," Bryant said. "It's exactly the people we wanted to talk to. These are the people who talk to the uninsured on a routine basis."

WVAHC will also be hosting 14 regional training sessions, Bryant said.

For the state's uninsured population, enrollment in the state's health-insurance marketplace and its expanded Medicaid program begins Oct. 1, with coverage starting Jan. 1.

A survey from Enroll America said 78 percent of the nation's uninsured did not know that health-care reform will help them, said Rachel Klein, executive director of the agency, which aims to enroll Americans in health insurance under the Affordable Care Act.

Klein said there needs to be a broad, disciplined effort to get the message out about health insurance enrollment.

"We want to be conscious about who we want to reach," she said. "We can shout from the rooftops, but if we're on the wrong rooftop, using the wrong words, we won't get the info to the people who need to hear it."

Joanne Grossi, region III director for the U.S. Department of Health and Human Services, said her agency will be attending conferences like the one WVAHC hosted all summer to get the word out about enrollment.

The state and the federal government will share the responsibility of the health-insurance exchange, an online portal where people can compare and purchase health insurance plans, Grossi said.

The state got $10 million in federal funding to run its insurance marketplace, Grossi said. West Virginia will oversee what insurance plans go into the marketplace and will be responsible for enrollment.

"We'll kind of do everything else for the state," Grossi said.

A separate marketplace, called the Small Business Health Options Program, or SHOP, will offer small business owners plans for their employees. Businesses with fewer than 50 full-time employees are not required to offer insurance, she said.

The federal government will have its own multimedia campaign about the marketplace. While the details haven't been finalized, Grossi said the campaign will begin this summer and will likely include public events, social media, cable advertisements and partnerships with professional athletes who will serve as spokespeople for the marketplace. The campaign will target the healthy 18-35 age group.

"Because, to be honest, you need the healthy people coming into the system too in order to ... offset the costs for people who aren't [healthy]," Grossi said.

People will be able to enroll by mail, online, in-person or by a 24-hour call center, she said.

The federal government will also give $2.5 million to federally qualified community health centers in West Virginia for outreach and enrollment of the uninsured population.

The state will get another $600,000 for so-called "navigators," or federally -selected agencies that will educate the public and assist in enrollment

At least two agencies in the state will be designated as navigators, Grossi said.

"If you get afforded the money must make sure you're doing outreach and enrollment across the whole state," she said.

DHHS will also provide free training for certified application counselors, or volunteers that will help people apply for insurance or Medicaid. Because they won't be paid positions, these will most likely be people who have a vested interest in seeing people gain health insurance, for instance people who work in a hospital emergency room, Grossi said.

The state's health insurance marketplace will offer four tiers of qualified health plans -- bronze, silver, gold and platinum. The plans vary depending on the percentage it covers before a customer must pay chip in with co-payments and deductibles.

A bronze plan covers 60 percent, while the platinum covers 90 percent, Grossi said.

"If you're 28 and healthy a bronze plan is probably going to work for you because it's a lower premium but higher co-pays and deductibles," Grossi said. "You're taking a risk that if you get sick you're going to pay much more out of pocket."

Financial assistance for health insurance premiums is available to those who make up to 400 percent of the federal poverty level, or $94,200 for a family of four. There is a separate financial assistance available for those who make up to 200 percent of the poverty level, or $58,000 for a family of four, Grossi said.

Insurance companies have until May 31 to apply to offer a qualified health plan through the insurance marketplace. Those plans must offer so-called essential health benefits, or packages of certain items and services. 

People who don't enroll in health insurance or Medicaid and are not exempt for one or more of nine reasons will see a penalty on their 2014 tax returns, Grossi said.  The penalty for the first year is $95 or the equivalent of 1 percent of a person's income, whichever is more.

In 2016, that penalty rises to $695 or 2.5 percent of a person's income, Grossi said.

Staff writer Kate Long contributed to this story. Reach Lori Kersey at lori.kersey@wvgazette.com or 304-348-1240.

 


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