Las Cruses Sun: "Thousands apply for New Mexico Medicaid"

More to be eligible for program Jan. 1

By Brook Stockberger
bstockberger@lcsun-news.com

LAS CRUCES >> About 43,000 New Mexicans have applied for Medicaid since Oct. 1 and as many as 20,000 of those will be eligible to start the program as of Jan. 1.
The Medicaid program in New Mexico will soon be known as Centennial Care and it will expand to take on more people as the Affordable Care Act -- better known as ObamaCare -- kicks in with the start of the new year. Already 550,000 New Mexicans -- about 1 in 4 -- are covered by Medicaid and, as coverage is expanded, the state projects that number to grow through the rest of the decade.
"We've revised the numbers up, and by 2020 as many as 205,000 more people (could be on Medicaid)," said Matt Kennicott, communications director with the state's Human Services Department.
Las Crucen Michael Marrufo said he applied online on Nov. 14 but does not yet know if he will be accepted.
"They shot me an email saying, 'You will receive a final decision from the New Mexico Department of Human Services,' So now I am waiting," he said.
Las Crucen Dave Meade said that he does not currently have health insurance and, with the expansion of Medicaid to include more people, he decided to try and enroll. He applied online last month and is also waiting to hear back.
"If they count our housing costs, which are quite high, I should qualify no problem," Meade said. "If they don't count for housing costs, maybe I won't qualify."

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He said that he has also enrolled for health coverage on the Affordable Care Act's federal website just in case he is not accepted on Medicaid.

Who is eligible?

As of the start of 2014, states that choose to expand Medicaid -- like New Mexico -- can set eligibility levels to 138 percent of the Federal Poverty Line, or about $32,500 for a family of four.
There are other criteria as well. The website yes.state.nm.us offers what it calls a "quick, easy and private way" for people to determine if they are eligible. In addition, people can contact the Income Support Division offices in Las Cruces at 655 Utah Ave., and at 2121 Summit Ct. The phone numbers are 575-524-6500 and 575-524-6568, respectively.

How to apply

Potential enrollees can also use the website yes.state.nm.us to apply or they can also visit the local offices.
"We got outreach to help sign people up at (other) locations as well," Kennicott said.
Both Memorial Medical Center and MountainView Regional Medical Center have pitched in.
"MountainView is helping people get signed up," said MountainView spokesman Kelly Duke, who pointed out that 20 people attended a seminar at the hospital on Friday.
Mandy Leatherwood with Memorial Medical Center said that MMC has six staff members trained as healthcare guides.
"They can help people with signing up for the New Mexico Health Insurance Exchange and the Medicaid expansion," she said.

Problems

Some people have expressed frustration with the sign-up process and even with the state.
Meade said he does not expect to hear back on his eligibility anytime soon based on a phone call he made to the state.
"I tried to get through and it took me a couple of days," he said. "Based on what they told me, it seemed like they hadn't even looked at my application yet. My impression was that it would be sometime in January or February."
Marrufo said the application process was a chore.
"The log-in was a pain," he said. "It took several tries and finally I got an email response from the health insurance marketplace telling me that they knew I was having problems with the site and to try logging in again and complete the registration (so) I did."
Kimmarie Hartley applied on Oct. 6 and received a letter that she was not accepted on Nov. 4. She said that she was denied because she does not have any minor children, but she believes, under the expanded program, that should not matter. She will be covered by Medicare in March, so she has decided not to appeal the process. But her daughter, who also applied, was sent a denial letter too for the same reason. The problem? She has a minor child.
Hartley said her daughter has filed an appeal and was told she'll have to wait a month before she learns more.
Kennicott said people can file appeals with an ISD office.

Brook Stockberger may be reached at 575-541-5457.

Sebelius Announces Three Affordable Care Act Deadline Extensions

Sebelius Announces Three Affordable Care Act Deadline Extensions

Friday, December 13, 2013

On Thursday, HHS Secretary Kathleen Sebelius on Thursday announced that her department is implementing a trio of Affordable Care Act deadline extensions intended to ease the transition to coverage in the law's new insurance marketplaces in 2014, Modern Healthcare reports (Demko, Modern Healthcare, 12/12).

Sebelius said that changes were prompted by the various technical issues that plagued the online marketplaces --particularly the federal health insurance exchange -- when they were launched in October, which caused problems and delays for consumers when they tried to enroll in health plans. As a result, she said many consumers will need more time

to select and pay for the new coverage (Pear, New York Times, 12/12).

Sebelius said HHS has: Officially asked insurers to honor the new Dec. 23 deadline for coverage that begins on Jan. 1 (Kliff, "Wonkblog,"

Washington Post, 12/12); Urged insurers to give consumers more time -- until Dec. 31 -- to make their payments for coverage that begins Jan. 1

and asked them to accept late or partial payments for coverage (New York Times; 12/12); and Extended by one month -- through the end of January 2014 -- the federal Pre-Existing Condition Insurance Plan, which

has been providing coverage to about 100,000 U.S. residents with severe health conditions who were unable to purchase private coverage prior to the ACA (Galewitz, Kaiser Health News, 12/12).

An HHS fact sheet said the department "will consider moving [the Dec. 23] deadline to a later date should exceptional circumstances pose barrier to consumers enrolling on or before" that date (Young, CQ Roll Call, 12/12).

In addition, Sebelius announced that:

HHS has asked insurers to provide "retroactive coverage for people who sign up after Jan. 1," meaning that if a consumer signs up for coverage on Jan. 5, his or her coverage still would be effective on Jan. 1; and

Some consumers who experienced unique problems with signing up for coverage in the federal or state exchanges would be eligible for a "special enrollment period," which will provide them with extra time to complete their enrollment (New York Times, 12/12).

Officials in the Obama administration said that they are encouraging insurers to make additional voluntary accommodations for new enrollees, such as:

Continuing coverage for patients' preferred physicians, even if they are out-of-network under their new coverage plan (Modern Healthcare, 12/12); and12/13/13 Sebelius Announces Three Affordable Care Act Deadline Extensions - California Healthline

Providing temporary coverage for prescription drugs beyond Jan. 1, even if the drugs are not on the plans' list of approved

medications (New York Times, 12/12).

Reactions

In a statement, America's Health Insurance Plans CEO and President Karen Ignagni criticized the new changes, saying that "continued changes to the rules and guidance could exacerbate the challenges associated with helping consumers through the enrollment process." She added, "Health plans will continue to do everything they can to protect consumers from potential coverage disruptions caused by the ongoing technical problems with HealthCare.gov" (CQ Roll Call, 12/12).

Some Republican leaders in Congress also criticized HHS' move. Rory Cooper, a spokesperson for House Majority Leader

Eric Cantor (R-Va.), said, "It's clear that the administration knows Obamacare's problems are only going to get worse, and

patients will be the ones who suffer

Eight Northern Indian Pueblos Council Inc. " Creating a culture of Coverage"

Get Covered this Holiday Season!

WOULD YOU LIKE INFORMATION REGARDING YOUR COVERAGE OPTIONS UNDER THE AFFORDABLE CARE ACT (OBAMACARE)?

You may be eligible for no or low-cost, high quality health insurance coverage.  

If you are a single adult and your income is less than $15,856 a year, you may be eligible for no-cost coverage.  If your income is less than $34,470, you can receive financial assistance to purchase a low cost health plan and may not have to pay any out of pocket expenses (i.e, co-pays, deductibles).

The Eight Northern Indian Pueblos Council, Inc. (ENIPC) is offering confidential, unbiased assistance to help Pueblo members navigate through all of the options available to Native Americans in this process.  

Please note that with Obamacare, if you already have coverage offered by your employer that is "affordable" (amounting to 9.5 % or less of your total household income), you are not eligible to shop in the Exchange Insurance Marketplace.  For those who are eligible, to obtain coverage starting January 1, 2014, the deadline to enroll is December 23, 2013, although Native Americans benefit from an ongoing monthly open enrollment period.  Native Americans are also exempt from requiring insurance coverage, without incurring any penalties. if they decide to opt-out.

A Certified Health Guide/Navigator will be on-site at the Nambe Pueblo Tribal Administration Building every Monday from 1 p.m. to 5 p.m., to assist you with information and application enrollment assistance, both with the Marketplace Insurance Exchange (healthcare.gov) and Medicaid applications.  For preliminary assistance and/or to set up a free in-person appointment, call our toll-free line at 1-855-241-8137, or just drop by!  

Protect yourself and your family from unforeseen medical expenses and get the care that you need.

Community Catalyst Blog Post "States to Decide Medicaid Eligibility for Same-Sex Couples"

http://www.communitycatalyst.org/blog/states-to-decide-medicaid-eligibility-for-same-sex-couples    

States to Decide Medicaid Eligibility for Same-Sex Couples

Posted on: November 25 2013 10:48 am 

The Supreme Court’s decision on the Defense of Marriage Act (DOMA) was met with much elation by advocates pursuing marriage equality. The federal government has been working, since that momentous decision was released, to clarify just how it impacts various types of health insurance coverage. Most recently, the Center for Medicare and Medicaid Services (CMS) released guidance about how states should make most Medicaid eligibility determinations* for same-sex married couples. This guidance lets states choose whether or not to recognize the marriages of same-sex couples in determining adults’ eligibility for Medicaid.

In states already allowing same-sex marriage (regardless if passed by court ruling, legislative action, or popular vote), this should be a non-issue: states will likely recognize all married couples for benefit determination. The real question is whether states that do not allow same-sex marriage will recognize the marriages of couples who live in a state without marriage equality but were wed in a state that allows it.

It’s important to note that no matter what states do about Medicaid eligibility, the IRS will recognize marriages of same-sex couples regardless of where they live (as long as they were married in a state that allows it) when determining eligibility for tax credits in the Marketplaces for private health insurance. The CMS guidance essentially lets states decide whether or not to align their Medicaid eligibility rules with these Marketplace rules.

What’s at stake

Eligibility for Medicaid is based on two factors that could be influenced by whether a person is considered married: household income and household size. So in states that have not chosen to recognize legally-married, same-sex couples, those couples will sometimes be eligible for different insurance options than different-sex couples at the same income level. Also, some same-sex couples will be required to sign up for two different insurance plans rather than being on one plan together.

For example, imagine a legally-married, same-sex couple: John and Jeff. John earns $16,000 a year, or 139 percent of the federal poverty limit (FPL) if John were considered a household of one. Jeff earns $4,000 a year, or about 35 percent FPL for a household of one. They live in Arizona, where same-sex marriage is not legal. But, they were married in Massachusetts, where it is.

If they were a different-sex couple, Arizona would automatically treat them as a household of two with an income of $20,000 (or 129 percent FPL.) At that income, they would both be eligible for Medicaid; they would be able to enroll in a Medicaid plan without any premiums.

But, the CMS regulations allow Arizona to determine how to qualify this family. If Arizona chooses to recognize John and Jeff’s marriage from Massachusetts, they will qualify in the same way a different-sex couple does, and find them Medicaid-eligible. But, if Arizona chooses not to recognize their marriage, only Jeff would qualify for Medicaid (since he earns 35 percent FPL as an individual). John, who earns 139 percent FPL as an individual, earns just a bit too much for Medicaid when he’s considered a household of one. He may qualify for tax credits on the Marketplace, but he will be on a separate plan from his spouse and will likely have to pay premiums for that plan.

Even though in this example, John and Jeff’s marriage recognition resulted in lower costs, and Medicaid eligibility, there may be other circumstances where Jeff and John encounter higher health insurance costs as a married couple. But, this is not different from the various situations any married couple—gay  or straight—regularly  faces. At the end of the day, if we believe that all married couples at the same income level should be eligible for the same financial assistance, and if we believe that same-sex married couples should have the same opportunities as different-sex couples to be on the same plan as their partner, then we need state Medicaid departments to recognize the marriages of legally-wed same-sex partners.

Next steps

All states will have to submit a State Plan Amendment to specify whether or not the state recognizes same-sex marriages for the purposes of Medicaid and CHIP eligibility. Details about the timing of that State Plan Amendment are still forthcoming, but it’s never too soon to check in with your state Medicaid Department to figure out how it plans on handling this decision.

*An important caveat: This guidance only applies to Medicaid applicants whose eligibility is based on Modified Adjusted Gross Income, which is most low-income people applying as parents or childless adults. Guidance governing eligibility determinations for others (such as people who need long-term services and supports, people who qualify based on being blind, disabled or elderly, people in foster care, etc) is forthcoming.

ACA "Obamacare" Outreach Education presentations From NAPPR

Good Afternoon all,

As you may be aware Native American Parent Professional Resources (NAPPR) Inc., in Albuquerque, has been contracted, by NM HIX, as the Umbrella organization to provide outreach, education, and enrollment services to NM Native American Communities.

NAPPR has subcontracted with several Pueblos, Tribes and Consortium agencies to provide those services on their home communities. Part of the contract is to hire Native American Healthcare Guides that perform presentations in communities and provide onsite enrollment into Medicaid and NM HIX.  A Healthcare Guides role is to provide free impartial assistance in enrolling into the appropriate healthcare program, on an individual basis.

To set up an appointment with a Healthcare guide in your Community or from NAPPR call Toll Free 1-855-241-8137, or visit www.bewellnm.com

To schedule an outreach/educational event in your community contact Colinda Vallo 505-933-0079 or CVallo@nappr.org



Navajo Nation individuals for enrollment assistance contact:

Farmington:

Sheri Spencer
Irene Shorthair
Total Behavioral Health Authority
1615 Ojo Ct
Farmington, NM 87401
505-564-4804

Gallup:

Emily Wilson 505-863-6842
Stella Garcia 505-863-7266
Daisy 505-863-7130
College Clinic
2111 College Dr.
Gallup, NM 87301

NM HIX NA Advisory Committee Meeting UPDATED!

The Next NM HIX Native American Advisory Committee meeting will be on December 4th at the Indian Pueblo Cultural Center, starting at 1:00PM ending at 4:00PM

I believe that this is an open meeting.

For more information on NM HIX outreach activities visit www.nmhix.com and view the calender of events.

Feds extend Health Insurance Exchange enrollment by 8 Days

Health Law’s Enrollment Period Is Extended by 8 Days

By MICHAEL D. SHEAR and ROBERT PEAR

WASHINGTON — The Obama administration said Friday that it would give people eight more days, until Dec. 23, to sign up for health insurance coverage that takes effect on Jan. 1 under the new health care law.
Julie Bataille, a spokeswoman for the Centers for Medicare and Medicaid Services, said officials recognized that consumers might need more time to compare and select health insurance plans because of the technical problems that have plagued the online federal insurance marketplace since it opened at the beginning of last month.
The administration also said it would delay the 2015 insurance enrollment period for the Affordable Care Act by a month, pushing it beyond the 2014 midterm elections.
The decision means that people who have not signed up for insurance by the end of March will have to wait until Nov. 15, 2014, to apply again. The second enrollment period was previously scheduled to begin on Oct. 15, 2014.
It also means that insurance companies will have an extra month to set their rates for 2015 after taking into account who has signed up for coverage during the current enrollment period. The companies will now have until the end of May to set their rates for the following year.
“This gives them more time to assess the pool of people who are getting insurance through the marketplaces and make decisions about what rates will look like in the coming year,” said Jay Carney, the White House press secretary.
The decision to move the 2015 open enrollment beyond the midterm elections, which will be held Nov. 4, could help Democratic candidates who have been worried that another debacle involving the health care law’s website, HealthCare.gov, would hurt them just as they are facing voters.
Officials said the reason for the change was to give insurance companies more time to evaluate the success of the new insurance marketplaces, which have been dogged by technical and public relations problems.
The more young and healthy people who sign up during the initial enrollment period, the lower the rates will be the following year. Officials said they expected those customers to wait until the last minute to sign up and wanted to give insurance companies more time to set their premiums.