The Obama administration has promised that its troubled Obamacare website, HealthCare.gov, will be fully functional by Nov. 30. But Indiana officials expect it will be nearly a month after that before the federal site can correctly transfer individual account information with the state’s Medicaid computer systems.
In the meantime, Hoosiers will need to continue to pursue alternate routes to find out the kind of coverage they qualify for and to sign up in time to avoid an Obamacare tax penalty.
Obamacare was designed so that there would be no wrong ramp to use to get on the highway to health insurance. But because HealthCare.gov has been beset by technical failures since its Oct. 1 launch, Americans have been trying to wend their way through side streets to get coverage.
In Indiana, the state government is steering Hoosiers to a “screening tool” on its website, IN.gov/healthcarereform. The site received about 330 visits per day last month.
The site shows color-coded income tables for adults, children and pregnant moms. Each group of Hoosiers can see, based on the color that their income falls in, whether they should apply for Medicaid, for an Obamacare exchange policy or for a commercial health insurance policy off the exchange.
That kind of general guidance has been lacking on HealthCare.gov, because the federal government designed the site so that it verified applicants' incomes before giving them any guidance about which programs they qualified for. Many e-commerce experts have said that was a critical design mistake.
Indiana officials hope the tool helps Hoosiers start in the right place to begin with, so their information does not even have to be transferred from the federal site to the state Medicaid program, or vice versa.
“If you start in the right place, then you never have to worry about the account transfer,” said Debra Minott, secretary of the Indiana Family and Social Services Administration, which oversees the Indiana Medicaid program.
Hoosiers still can go to either HealthCare.gov or to IN.gov to apply for coverage, and they will—eventually—get routed to the correct destination. But the speed with which that happens is the issue.
Minott said her agency has received notification from the Obama administration that 6,000 Hoosier households that appear to qualify for Medicaid have entered applications on the HealthCare.gov web site. However, state officials do not expect to receive and be able to process the full applications until late-December.
If the Obama administration gets HealthCare.gov working by the end of this month, that should leave enough time for Hoosiers to sign up for coverage before Jan. 1, Minott said.
That was the day nearly all Americans will be required to have health insurance coverage. If they have not obtained coverage after 90 days, they will be on the hook for a tax of $95 per adult or 1.5 percent of household income.
A more pressing issue for Indiana officials is that some existing health insurance programs were scheduled to end Dec. 31. The state’s high-risk pool—which covers 6,800 Hoosiers with such conditions as cancer, AIDS and organ failure—was scheduled to end on that date, but the Indiana Department of Insurance extended it an extra month because of the problems with HealthCare.gov.
Minott is also concerned about the Healthy Indiana Plan, which will cease covering about 10,000 Hoosiers on Jan. 1 because of new income eligibility rules the state negotiated with the Obama administration.
Minott wants to be sure HIP enrollees can switch over to a policy on the Obamacare exchanges in time to avoid a gap in coverage. If it became necessary to extend HIP for those Hooisers because of the delays on HealthCare.gov, the state would need to get approval from the Obama administration.
While Minott and her staff have conversations with the agency responsible for that decision, the Centers for Medicare and Medicaid Services, Minott said the decisionmakers all have been consumed with fixing HealthCare.gov, and have not been able to give a definitive answer to her questions.
“At this point, it’s been radio silence,” Minott said.
State officials also had been talking with the Centers for Medicare and Medicaid Services about expanding HIP to cover Hoosiers with incomes up to 138 percent of the federal poverty limit—an expansion for which President Obama’s health reform law would pay nearly the entire bill.
But Obama administration officials have challenged Indiana officials to come up with new ways to structure HIP, Minott said. The Obama administration has especially questioned the health saving accounts used by HIP that require contributions from most participants, as well as a cap on spending for the program that has limited its enrollment to a fewer-than-expected 40,000 people.
“They’re really trying to challenge us to come up with other ways of doing that,” Minott said. And so, she added, state officials are “brainstorming” ways of preserving HIP’s principals of individual and fiscal responsibility, while satisfying the concerns of the Obama administration.
An earlier version of this story incorrectly stated that the Obama administration had mailed to the state of Indiana Medicaid applications that were stored on CDs. Instead, state officials now say, information about those applications has been uploaded weekly to a secure electronic portal.