Print pagePDF pageEmail page Medicaid Expansion Medicaid Expansion Black-hole

Several individuals have been running into challenges with the website when it comes to Medicaid eligibility. The issues starts when consumers applying for insurance put their income information into the subsidy calculator— manages and handles the health insurance exchange for 36 states who have defaulted to the federal government to manage their exchanges— When an individual uses the calculator it provides information on how much financial assistance they qualify for or if their income is low enough if they are eligible for Medicaid.  If an individual is eligible for Medicaid, the system does not allow the individual to obtain any subsidies toward the purchase of a health insurance plan on the exchange, their only option is to pay full price.

This error is a significant issue as the December 23, 2013 date approaches. December 23 is the last date to purchase a health plan that will begin on January 1, 2014. If the federal health care exchange incorrectly determines Medicaid eligibility, the individual must file an appeal with the federal marketplace. This is creating a health insurance black hole for some, Department of Health and Human Services spokeswoman Joanne Peters, says “she does not have an estimate on how long that would take.” to file an appeal and getting a response.

Since November 30, for the majority of Americans at least 3.7 Million is running smoothly, however the system does not seem to be able to handle complicated family or tax situations often resulting in technical difficulties, with that awareness the department of HHS has increased the number of call center employees and in-person assistants for people who need extra help.

Earlier this week the department of HHS indicated it will begin sending Medicaid application files to states since the’s mechanism to transfer accounts to state Medicaid offices is still not sufficient for state Medicaid offices, this is because the data received up until now does not provide the states with enough information to determine Medicaid eligibility.

“Claims from some states about our process for testing the Medicaid eligibility and enrollment systems are inaccurate,” says Joanne Peters. “We are eager to work with states to ensure their systems are functioning properly and to extend Medicaid coverage to those who are eligible through the generous Medicaid funding made possible by the Affordable Care Act.” Additionally HHS has told states they won’t be penalized if they enroll people in Medicaid who HHS erroneously said were eligible.


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