When New Jersey
resident Jacqueline Clay contacted me Monday, she was panicked and desperate.
Clay had applied
for health insurance on the federal marketplace last month. She had just been
diagnosed with breast cancer, was unemployed and didn’t have any income. She
was told that she appeared to qualify for Medicaid and that her application
would be forwarded to New Jersey officials for processing.
But she didn’t
hear anything back.
A couple weeks
later, Clay, 59, accepted a part-time job at a soup kitchen that will pay her
about $26,000 next year, enough to disqualify her from Medicaid. So, as any
responsible citizen would, she set out to update her application so she could
choose a private insurance plan with a subsidy on HealthCare.gov, which handles
enrollment for New Jersey and 35 other states.
That’s when she
hit a wall.
Clay called the
toll-free number for HealthCare.gov and was told by a customer service
representative that she would have to contact the New Jersey Department of
Human Services, which runs the Medicaid program known as New Jersey Family
Care. She called the state agency and was told they had no record of her
application.
This went on
for days. “It was back and forth,” Clay explained.
With the
looming Dec. 23 deadline to select a plan starting on Jan. 1, Clay felt she
could wait no longer.
“I am in limbo
and with my cancer diagnosis am really afraid that I will not be able to have
medical coverage as of January 1,” Clay wrote me. “I have had little treatment
because I currently have no insurance and wanted to start more treatment in
January.”
She concluded:
“I want everyone to know the big mess that is now occurring in New
Jersey. I cannot be the only person who needs to make changes … but
unable to do so.”
With Clay’s
permission, I forwarded her email on to a federal spokeswoman, who asked a
representative to get in touch with Clay. Separately, Clay called the office of
Health and Human Services Secretary Kathleen Sebelius
seeking help.
Clay was
finally told to create a new email address and fill out a new application, and
that would enable her to enroll in a private plan for Jan. 1. It appears to
have worked.
But her
experience raises two bigger, more troubling questions: 1) What should
consumers do if they can’t get the help they need on HealthCare.gov; and 2) Is
there a problem with applications for Medicaid on HealthCare.gov?
“Everybody
isn’t like me,” Clay told me yesterday. “I was going to put on my clothes and
go to Washington and speak to Obama if I had to. There are people out here who
don’t have the time, the wherewithal, the energy to do that.”
Indeed, Clay
can’t be the only one experiencing this problem. Federal officials encourage
consumers to ask for a supervisor if a customer service representative on the
toll-free line cannot resolve their problem. Clay did this and didn’t get the
help she needed.
But the bigger
problem may be those who signed up for Medicaid on HealthCare.gov thinking they
would have coverage beginning Jan. 1.
The Record newspaper
in New Jersey reported today that state officials said about 25,000 poor
people who applied for Medicaid on HealthCare.gov won’t be enrolled because the
information the state received from the federal government is “unusable.”
Their
applications can’t be processed, and they can’t yet be enrolled for
coverage that is supposed to begin next year, said Nicole Brossoie,
assistant commissioner of the state Department of Human Services, which runs
Medicaid.It
is yet another problem in the disastrous rollout of the federal marketplace for
people who want to sign up for health insurance. After assurances that the
federal website would automatically send enrollment information to the state
for those who qualify for Medicaid, New Jersey officials discovered this week
that the state and the federal computer systems don’t communicate smoothly.Worse,
people who think they enrolled successfully in Medicaid likely have no idea
that, in fact, their applications are in limbo.New
Jersey Medicaid “is working with the Centers for Medicare and Medicaid Services
to receive a usable file as soon as possible,” Brossoie
said late Thursday afternoon. She did not offer any timetable for resolving the
problem.
A spokeswoman
for the Centers for Medicare and Medicaid Services said the agency is working
with the state.
Clay said she had
health insurance her entire adult life until she was let go in April from her
job as a benefit manager for a medical company. “When you’re on unemployment,
you really can’t afford to get COBRA,” a program that allows employees to pay
for coverage from their former employers.
Clay said she
is happy with the plan she chose on the exchange, which will cost her about
$300 a month after a subsidy — and she feels grateful to be able to get
insurance with a pre-existing condition, something the Affordable Care Act
guarantees.
But she doesn’t
wish what happened to her on others. “This has been a harrowing experience,
having to hear that you have cancer and it’s in the lymph nodes,” she said, “then
to have to fight with the government to get what they said I’m entitled to.”
“It has been
just awful.”
Editor’s
Note: This post is adapted from Ornstein’s “Healthy buzz” blog.
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