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Health industry hurries to prepare for Affordable Care Act

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Gina Duwe
June 22, 2013

— If Carla Haigh wasn't elbow deep in helping Rock County plan for the Oct. 1 arrival of the Affordable Care Act, she admits she probably wouldn't know much about it.

“I would have little pieces of it,” she said.

As the economic support division manager for Rock County, she has been forced to learn about it, but surveys indicate thousands of those who will be affected by the sweeping federal health care law have no idea what it will mean to them.

One recent poll found that two-thirds of those without health insurance were unaware of how the Affordable Care Act would affect them.

Haigh is worried that Wisconsin isn't planning to train enough people to help all those applicants find coverage that's right for them.

The challenge ahead will be reaching hundreds of thousands of state residents who will be eligible for coverage and helping them through the complex process of signing up for Medicaid or a private health plan.

Statewide groups are working to take on the challenge, while Rock County officials are interviewing candidates to fill new jobs associated with the law's implementation.

“I would say the average citizen doesn't know (about the law),” said Joe Nemeth, vice president and chief operating officer of MercyCare Health Plans, which will offer plans on the health insurance marketplace. “At the same time, one of the reasons they don't know is we're developing this at the same time of implementing it.”

Against the clock

The health care industry and support services are working to get answers to questions about how to sign up new applicants. Under the law, every one will be required to have some kind of insurance or face a tax penalty.

Those who qualify will be able to shop for coverage on a federal insurance exchange. Enrollment runs from Oct. 1 to March 31.

From October to December, the county is expecting 1,200 BadgerCare applications, 2,400 applicants in the federal exchange and 1,300 people now on BadgerCare who will need to be converted to the new eligibility rules.

Over the next two years, the numbers jump to 5,500 new BadgerCare applications and renewals in Rock County and 8,800 marketplace inquiries.

One of the policies of the Affordable Care Act is there is “no wrong door,” Haigh said. If a person “opens the door” to the exchange and starts a search for a plan or if the person opens the door at the county office, “ultimately we're both responsible to get you in the right place,” she said.

The process is being streamlined to ensure only one application is started even if a person seeks help from more than one source.

“All of that coordination is ongoing,” she said.

The county's call center for BadgerCare programs already is receiving calls about Obamacare, but staff has nothing to give them.

“We need a coordinated effort of what to say,” Haigh said.

They are waiting for a fact sheet from the state.

The county will be one place where people can sign up for a health plan through the exchange, and Haigh said they're expecting the first waves of the flood in October, or as early as September, even though applications can't be processed until mid-November.

They are trying to prepare while much still is unknown.

The county is in the process of interviewing applicants who can't be hired until funding in the state budget is approved. Meanwhile, the state is finalizing details of how the federal law will be implemented and trying to coordinate outreach with groups and providers.

“We're still waiting for guidance from the state as to which of our (MercyCare) members are going to be changed,” Nemeth said. “At the same time, the legislature is still just passing the budget.”

Haigh's economic support staff might face mandatory overtime in the coming months to process current applications before getting slammed in October, she said.

“We can't afford to have this onslaught on top of being not current,” she said. “We're trying to work ahead, but we haven't started that yet.”

Who will help?

Rock County likely will receive nearly $400,000 in state and federal funding to hire and train 17 additional staff to help low-income people find their way in the new system.

These aren't the people, however, who will be able to help sort through which insurance plan is best for applicants, Haigh said.

“We will not take a person into the marketplace and have those conversations,” she said. “We can't. We won't have the training for it. The best we'll be able to do is try to get them to where they belong and hope they can take it from there.”

They will only help applicants process their applications.

So-called “navigators” will be trained to provide consumer assistance. The federal government has allocated $829,000 for Wisconsin navigators, and a plan calls for six navigators and two staffers to oversee coordination.

Funding will increase in subsequent years, but it is considered woefully inadequate for the first year, given the challenge of helping potentially hundreds of thousands of people as well as small employers understand the new law and their options.

“It's extremely lacking for the state of Wisconsin,” Haigh said. “It's scary to think.”

Nemeth took a more optimistic approach, saying the area has a tremendous network of people between provider and insurance networks and county social service staff.

“There's going to be a learning curve,” he said, referring to staff offering assistance.

The federal government has been pretty good about offering frequently-asked questions sites.

“I think it's going to be several years before it all settles down,” Nemeth said.

Material from a Milwaukee Journal Sentinel article was used in this story.



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