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Open Enrollment Healthcare Washington State: Week 3

1. Well, I found a first trap because of excessive exchange funding. This effects all clients that have had apple health. Clients are now able to get extensions automatically on their apple health up to a year at a time. I have a family that is now at 200%+ of the poverty level that was granted this extension. Their healthcare is paid by tax dollars and as their broker I receive zero commission. Would you like to make $60,000+ a year and have medicaid for the entire family? Previous to the ACA brokers were paid $100 per enrollment with an average of 10% of people a year coming off medicaid during any given year.

2. If you have been following this was an excerpt from a Health Care Authority recent audit sent Oct 23rd.

HCA regularly conducts audits of Washington Apple Health eligibility. Recent audits by HCA found numerous cases of inaccurate income reported on Washington Apple Health (Medicaid) applications in Healthplanfinder. Clients found to have discrepancies in their reported income are identified through a post-eligibility review and are required to provide verification of their actual gross income to maintain coverage.

Navigators and other assisters are expected to assist clients in reporting their correct gross monthly income on Healthplanfinder applications. Gross monthly income is the income earned before any taxes or deductions are taken out.

Intentionally under-reporting income to qualify for insurance coverage is insurance fraud and my result in severe penalties for the assister, the provider, and the client. The penalties can include but are not limited to loss of coverage, provider referral to the Office of Program Integrity, termination of pri9vileged user access in Healthplanfinder, and criminal prosecution under Washington State Law.

So with the two policies in place there will be a fair population that are receiving health insurance on the tax payers roll that qualified for expanded medicaid in the first place. If the audit was bad enough to send out a reminder, how bad it is only the HCA knows for certain.

3. Premera recently took the unpleasant step to transition to a manual process for applications because we're experiencing issues with people acting as brokers without proper credentials and training, purposefully circumventing our third party payer requirements, and enrolling individuals who don't meet state residency requirements. As a result, we are taking additional steps with five pieces of proof of residency along with wet signatures for business written outside of the exchange. This impacts primarily non-residents with very limited options in purchasing insurance in Washington State.

It is pretty clear that the licensed and regulated brokers are receiving less compensation for their work while unregulated are breaking the law, costing policy holders and tax payers money. Insurance is based upon laws and regulation. Tax payers are consumers of this program and they are being exploited by not policing navigator groups. The downfall of these poor practices will be the increased tax burden and decrease in regulated brokers assisting the consumers. If the ACA fails, then the next generation program will fail again because the 'experienced' people will perpetuate the wasteful spending and poor services.

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Location: Suzie Health Solutions

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