July 23, 2013 in City, Health

Washington’s Apple Health aims to simplify Medicaid

By The Spokesman-Review
 
Expanded Medicaid coverage

• On Jan. 1, government-funded health care coverage will be available to Washington adults whose incomes fall below 138 percent of the federal poverty level: $15,856 for one person; $21,404 for a family of two; $26,951 for a family of three; $32,499 for a family of four.

• To apply for expanded coverage, visit www.wahealthplanfinder.org after Oct. 1.

In political circles, “Medicaid expansion” has been a phrase that launches arguments. But for uninsured poor people – 22,000 in Spokane County and 328,000 throughout Washington state – expansion means health care coverage is on the way.

Last month, the Legislature made Washington one of 24 states to accept the federal government’s offer to fund the expansion of Medicaid, the health care program for America’s poor.

The expansion takes effect Jan. 1.

Declaring that expansion will simplify coverage, the state announced last week that expanded Medicaid will have a new name: “Apple Health.” It’s a label that has worked before, officials said. In 2008, the state consolidated its children’s programs under the name “Apple Health for Kids.” This became “a reassuring brand name, one that remains very popular with parents,” said Dorothy Teeter, director of the state Health Care Authority.

Now that Medicaid is becoming a comprehensive plan for adults, Teeter said, she hopes the public will learn that “Apple Health means health care coverage: regular doctor visits and a healthier future.”

Gone, the state hopes, will be desperate trips to emergency rooms, provider of last resort for the uninsured.

Gone, too, will be the long waits for eligibility determinations and the complex patchwork of state programs that cover some low-income people but not others. In the past, children or pregnant women could get Medicaid coverage, for example, but healthy, childless adults usually could not.

Under Medicaid expansion, government-funded coverage will be available to everyone below 138 percent of the federal poverty level (income of $15,856 for one person, $21,404 for a family of two, $26,951 for a family of three, $32,499 for a family of four).

Those expanded eligibility limits apply to adults. Children enjoy better coverage. Washington, more generous than many states, already extends Medicaid to children up to 200 percent of poverty level, and for families that pay a premium, it extends Medicaid to children up to 300 percent of poverty.

This expansion of Medicaid was authorized under the Affordable Care Act of 2010, also known as Obamacare. In addition to the broadened eligibility, Medicaid expansion makes it simpler to apply for coverage. That’s because the federal law authorized insurance-buying websites. States that choose to take part can use these sites to replace their Medicaid processes.

Today, it can take up to 45 days for Washington’s agencies to investigate and approve a Medicaid applicant.

But to apply for Apple Health, Washington residents will go to a new government website where officials estimate that it will take 20 to 40 minutes, depending on family size, to fill out the form and get coverage. This “Health Plan Finder” website, www.wahealthplanfinder.org, is the same place where all uninsured Washington residents will be able to shop for 2014 health coverage.

The site begins processing applications Oct. 1. After applicants enter their income information and their inputs are validated against government databases, the site automatically will direct them either to the Medicaid process or the shopping cart for a private health insurance policy.

All Medicaid applicants – current clients as well as new ones – will use this new site. Sometime in the coming year, existing Medicaid clients will receive a letter, state officials said, explaining that it is time to reapply for their coverage and outlining how to do so. Those who lack Internet access can visit a state office or call a phone assistance line.

Medicaid already covers 103,172 Spokane County residents and 1.2 million Washington state residents. The expansion of eligibility is expected to attract new enrollments gradually, officials say, with the number growing by an estimated 22,000 in Spokane County and 328,000 statewide by the end of 2017.

From the standpoint of a client, Medicaid closely resembles a private insurance program: Five private health insurance companies provide the coverage, under the oversight of the state Health Care Authority. When coverage is approved, clients are directed to an insurance carrier that operates in their community, and each client is assigned to a physician or a medical office. Most Medicaid coverage is handled on a “managed care” rather than “fee-for-service” basis. Medicaid has no co-pays or deductibles to deter its low-income clientele from seeking preventive care, and it encourages providers to manage care for the chronically ill in a way that keeps them well and out of hospital emergency rooms.

For complete information about Medicaid’s expansion plans, see the state’s website at hca.wa.gov/hcr/me/Pages/ index.aspx.

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