By Suzanne Wikle
The COVID-19 pandemic reminds us how fragile our health insurance system is and how, too often, insurance is either tied to someone’s job, unaffordable and/or completely inaccessible. The crisis is forcing people to scramble to find health insurance, perhaps because they or their spouse lost a job that provided insurance or they were uninsured but now still have more afraid of not being insured.
Many workers who have finally been recognized as “essential” in our communities – child care providers, grocery store clerks and cashiers, gas station attendants – are often the same ones who are uninsured . Most low-wage jobs, which are disproportionately held by people of color, do not provide health insurance or have unaffordable payroll taxes if they do.
Today more than ever, it is important to expand access to health coverage. This is especially true for our frontline essential workers who work in jobs that have historically been less likely to have insurance. This is also true for people who have been laid off but need access to health care to return to work, such as child care providers who are temporarily closed. Below, we outline enrollment options for individuals and steps for states to take to make insurance more accessible.
Health insurance enrollment options for individuals:
- Meet (in person or by phone) an expert. The Affordable Care Act (ACA) has created jobs called Navigators and Certified Application Advisors (CAC) to help people determine what they are eligible for, how to enroll in coverage and how credits work. taxes and subsidies. You can find a list of navigators and CACs in your area and book an appointment through this resource.
- See if you are eligible for Medicaid in your state. You can apply in person, by mail or online through your national health and social services agency or via health.gov. Because there are no open enrollment periods for Medicaid, you can enroll at any time if you are eligible. Medicaid eligibility is based on your current monthly income, so if you’ve recently lost a job, you’ll likely be eligible. if your state has extended Medicaid. In a non-expanding state, it is much more difficult to qualify for Medicaid. However, you may be eligible if your household income has been eliminated or nearly eliminated. and you are pregnant, disabled Where have dependent children at home.
- If you exceed the Medicaid income limit, you may be eligible for subsidies (through tax credits) to help you purchase insurance in the ACA market. Subsidies are available for households earning between 100% and 400% of the poverty level (138% to 400% in Medicaid expansion states). Go to healthcare.gov to start this process.
Unlike Medicaid, to enroll in Marketplace coverage outside of the typical open enrollment period (held annually in the fall), you will need a “qualifying life event,” such as loss of employer health insurance. If so, you qualify for a Special Enrollment Period (SEP). The most common qualifying life events are loss of employer insurance (note that losing a job does not trigger MS; you must lose insurance with your job loss), marriage, childbirth, and moving house.
When exploring health insurance options, people should be wary of anything that is not certified as a qualified health plan. People may see short-term or association plans advertised, but these plans don’t offer the protections of the Affordable Care Act. As such, they may not cover pre-existing conditions and may have a limit on the expenses they will cover, among other limitations.
States can take these steps to make insurance more accessible:
- Expand Medicaid. Fourteen states have yet to expand Medicaid, leaving 2.3 million people undercoverage — meaning they earn too little to receive tax credits to buy insurance on the market, but they earn too much to be eligible for Medicaid—and unable to access affordable health insurance. In the face of a global pandemic, states should rush to expand Medicaid, which both provides health insurance for the uninsured and offers some tax relief from the effects of the pandemic on state budgets.
- Amplify Medicaid. States should do everything possible to find people who are eligible for Medicaid but not enrolled. Strategies to do this include matching data with other programs (for example, people receiving SNAP who are not receiving Medicaid), partnering with other resources people turn to for help during this crisis (eg, unemployment insurance, food banks, faith-based organizations) and the use of and earned media for mainstream outreach efforts.
- Simplify Medicaid. During this crisis, states will see an increase in Medicaid applications at the same time that they are likely understaffed or struggling to implement remote work for social workers. Do everything possible to simplify and streamline the application and registration process, while diverting staff time from unnecessary paperwork or verification, is the most efficient approach. Among the approaches states can take are expanding presumptive eligibility, maximizing self-attestation, and extending reasonable opportunity periods. The Centers for Medicare & Medicaid Services (CMS) has proposed a model State plan modification outlining many changes states can make to enroll people as quickly and efficiently as possible.
In the 37 states that have expanded Medicaid, most low-wage workers can be covered, but we know that not everyone who is eligible enrolls, at least in part because of paperwork and bureaucracy in the application process, which is why simplification helps.
- Create special registration periods. States with their own health insurance exchanges (rather than the federal market) may add special enrollment periods beyond those required by the ACA. To date, 12 with this option have chosen to implement a special registration period now, allowing people to register during the COVID-19 crisis.
- Implement a state-only Medicaid program to insure essential workers. States have the option to cover people otherwise ineligible for Medicaid if they choose to use state funds for all costs, rather than the typical shared costs between state and federal government. This option, although at state expense alone, allows states to provide Medicaid coverage to people who are not otherwise eligible for Medicaid. In times of crisis such as the COVID-19 pandemic, States should consider this option.
- Providing public funds to help people buy exchange coverage. People stuck in the coverage gap or otherwise ineligible for subsidies in the market can still buy coverage, but at full price (unfortunately, this is not the case for undocumented people). States could offer funds to pay premiums and cost-sharing obligations for market coverage. It’s likely more expensive than the previous option, and people would still need to qualify for a special sign-up period for this option to be viable in states using the federal market.
In a similar move, the State of Washington is asking CMS for permission to use Medical help dollars to help people covered by Marketplace better pay their premiums and cost-share. The state’s proposal would use Medicaid dollars to dramatically reduce or eliminate out-of-pocket premiums, copayments, and deductibles for people enrolled in a qualified health plan whose income is less than 200% of the poverty. *Update: CMS rejected this request from Washington on April 21, 2020.
In this time of crisis, states must take all necessary steps to connect people to health insurance. And, people need to understand their options, which unfortunately vary widely depending on whether their state has expanded Medicaid. Our attention during the COVID-19 pandemic should rightly be focused on connecting people to coverage. However, we also have to face the reality that our current health insurance system still excludes too many people, is unaffordable for many, and is often cumbersome and too difficult to navigate. As we look beyond this pandemic and our options for improving the system, CLASP has outlined principles that policymakers should incorporate into the next steps of our country’s health care reform.