Stanley Feld M.D.,FACP,MACE
Every congressman should try registering a poor (below poverty level) constituent for Obamacare aid.
If you have not, you do not deserve to be in office or have a vote.
Most of you know my story of Moses and his healthcare insurance. I have tried to obtain Medicaid healthcare coverage for both Moses and his wife in the past in Texas. I failed after trying hard.
I had been successful in registering his kids for SCHIP.
Moses annual income qualifies him and his family for Medicaid in Texas. Texas is a state that isn’t expanding Medicaid.
You might recall that Medicaid is not great insurance. The reimbursement is extremely low and there are few physicians who participate.
If Moses lived in a state that is expanding Medicaid, he could earn up to $32,500 dollars per year and still qualify.
"If your state is expanding Medicaid, you’ll probably qualify if you make up to about $15,800 a year for 1 person ($32,500 for a family of 4). (These are 2013 numbers, and likely to be slightly higher in 2014.)"
"If your state isn’t expanding Medicaid in 2014
Some states aren’t expanding their Medicaid programs in 2014. If you live in one of these states, you may not have as many options for health coverage. It will depend on where your income falls.
- If you make less than about $11,500 a year as a single person or about $23,500 for a family of 4, you may not qualify for lower costs for private insurance based on your income. However, you may be eligible for Medicaid, even without the expansion, based on your state’s existing rules.
Moses earns less than $23,500 a year. He should qualify for Medicaid in Texas.
I have encouraged him to apply for Medicaid using the Obama Health Insurance Exchange in Texas. Texas has a federal Health Insurance Exchange.
I offered to help him fill out the application online at the beginning of December. He did not want to bother me.
He said he had a friend in North Texas who works for one of the Texas insurance companies. He said his company has people who help people like Moses fill out the healthcare insurance application. He said they are called Navigators.
I told him the Navigator should be able to help him complete the application. The insurance company assigned him a Navigator in Las Vegas, Nevada.
Moses said she was very nice. She asked Moses all of the questions over the telephone.
I called him on December 12th and asked him if he had insurance yet. If you recall President Obama extended the deadline for applying until December 23th and then December 31th in order to have coverage for January 1st, 2014.
Moses said she told him she did not understand why his application was not accepted. I told him to call her every day and find out what is going on.
She was going to try again the next day. It sounded like she tried at least every other day through December 31st and failed to get any information or his application accepted.
I told him to keep having her try. This went on through the next extended deadline of January 15th. She said could not understand it. I couldn’t understand it either.
Everything I read said the web site healthcare.gov was working smoothly. However, the back end was not connected to the application process.
She was unsuccessful through January 30th. On January 30th I told him to come over. I would try and I would fill out an application online for him.
Again he did not want to bother me. I insisted. In the meantime another friend in North Texas connected him with a Spanish speaking Navigator in North Texas.
The Navigator called him when we were about to start filling out the application. After speaking with Moses in Spanish, he asked to speak to me. He practically begged me to let him complete the application for Moses and get him healthcare insurance.
I said O.K.
He asked Moses to come over to him that afternoon. Moses went to him. They spoke for an hour. He then gave Moses a list of questions and a telephone number to call.
Moses told me the questions were complicated. He was afraid he would make a mistake in answering them. The Navigator told him he would not get Medicaid but he could buy a number of insurance policies.
I told him to let me try to register him online.
Last Thursday Moses came over to the house with his citizenship papers and social security numbers of his wife and two kids.
I started to complete the form at 9 am. I completed the form for him at 11.30 am. The form was long and tedious.
Ten seconds after the application was completed the health insurance exchange acknowledged the submission of application. It then accepted the application.
The next screen asked if I wanted to see coverage the applicant was qualified to receive. Within four minutes of accepting the application the message was sent that the application does not qualify for Medicaid.
This decision seems impossible. Healthcare.gov is not connected to insurance carriers or government databases. The decision was too fast. It would have had to be done by hand.
In any event I clicked on the coverage the application was qualified for. As I clicked on that I noticed there was an appeals button on the previous screen. I figured I could get back to the appeals button shortly.
He was given a choice of healthcare policies. There was no discussion of the possibility of government subsidies.
See below.
The deductibles offered for his income level were outrageous. The lowest deductible was $1500 which he couldn't afford it.
It was painful to see the dejection on his face.
I tried to re-log into his application. Healthcare.gov would not recognize the registration number they had given him fifteen minutes earlier.
Where is his application?
When will he receive notification of his eligibility for subsidy?
How much subsidy will he receive?
How does he appeal the Medicaid decision?
Is there anyone out there that can help?
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.
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