Colorado health exchange pushes for streamlined insurance application

Posted: 11/11/2013 03:54:36 PM MST

Updated: 11/11/2013 04:04:44 PM MST

The Colorado health-exchange board pushed hard Monday for a faster overhaul of complex Medicaid and insurance applications, warning of a looming Dec. 15 deadline for those stuck in computer purgatory.

Consumers trying to enroll in private insurance plans under the Affordable Care Act must fill out a lengthy Medicaid application, and then wait to be approved or denied, before moving to the next step.

If Medicaid takes its full 45-day legal limit to give a response, current buyers will miss the Dec. 15 deadline to have coverage begin or continue on Jan. 1, exchange board members warned.

The Connect for Health Colorado board is working with officials at Medicaid on both short- and long-term fixes. Many officials and consumer advocates believe the multi-step process is one reason exchange enrollments in Colorado are so low, at about 3,400 in six weeks.

'This is people who want to join us but can't because of the collective challenges we have,' said board member Steve ErkenBrack, president of Rocky Mountain Health Plans in Grand Junction.

'I'm sitting on day 36' waiting for Medicaid's answer, said health-care activist Donna Smith, who has battled cancer and needs new coverage. 'This is a very real human issue, and day 36 is making me very nervous.'

Medicaid officials stress their application changes must be approved by federal bureaucrats. ErkenBrack said the response to that should be, 'We're doing this, sorry if you don't like it, our job is the Coloradans who need coverage.'

Non-voting exchange board member Sue Birch, director of Medicaid's overseer in Colorado, the Department of Health Care Policy and Finance, said simplification is under way. A set of customer-asset questions that were irrelevant to both Medicaid expansion and private-exchange insurance were dumped from the application process in a computer fix Friday night, Birch said.

Connect for Health chief executive Patty Fontneau said the exchange and Medicaid will work to launch a unified, greatly simplified application by the next open-enrollment period in October 2014. Consumer advocates who spoke at a meeting Monday urged them to move up that deadline.

'Can we make this really simple? That's all I'm asking,' said exchange board member Sharon O'Hara .

ErkenBrack and other board members expressed fears for the coverage and peace of mind of nearly 250,000 individual policy-holders notified that their 2013 insurance will not exist in 2014. Many of those have been told by their insurance carriers that their existing policies do not meet new minimum benefit and cost-containment rules in the Affordable Care Act.

They are scrambling to find new coverage, often on the exchange web site. Federal rules require them to check first if they qualify for the expanded Medicaid program; if not, they are meant to receive an instant 'denial' and then start shopping for policies and possible subsidies on the Connect for Health exchange site.

Despite a 12-page application with questions irrelevant to many private customers, most people get a Medicaid answer within 24 or 48 hours, Birch said. The average time to clear people required to fix a mistake or provide documentation has been 16 days.

Customers must enroll in a new policy and make a payment by Dec. 15 to be covered Jan. 1, even though open enrollment for 2014 lasts through March 31. Consumers starting now don't have 45 days to wait under Medicaid rules, board members noted.

Colorado's one of 14 states that is running its own exchange under Obamacare, and its problems are separate from those plaguing the federally run website.

The state Division of Insurance, meanwhile, said it will hold four pubic hearings around the state for consumers with canceled policies to vent frustration and seek answers. Insurance commissioner Marguerite Salazar announced the hearings in a phone conference with the board, but the office did not release dates, places or times.

Michael Booth: 303-954-1686, mbooth@denverpost.com or twitter.com/mboothdp