Health

Gov. Matt Bevin’s administration says HealthCare.gov will be up and running in Kentucky in time for Kynect customers to reapply for their health insurance later this year.

But roughly one month from the beginning of open enrollment on Nov. 1, some of those who work on the ground to help Kentuckians sign up for coverage are concerned about whether exchange customers will know when, where and how to re-enroll. That’s in part because education and outreach efforts have thus far been minimal.

Kentucky is moving from its state-based marketplace to the federal HealthCare.gov this year, after Bevin decided to dismantle Kynect and roll back Medicaid expansion in the state. Consumers must reapply this year for 2017 coverage even if they were auto-enrolled last year because eligibility information from Kynect won’t be transferred to the federal system.

The window for open enrollment is Nov. 1 until Jan. 31. But to get coverage starting Jan. 1, enrollees must sign up by Dec. 15. Amanda Stamper, press secretary for the governor’s office, said they’ve hit milestones to make the switch in time.

“We’ve also been working with [the Centers for Medicare and Medicaid Services] and stakeholders to develop a comprehensive outreach plan to ensure people have the information they need well before open enrollment to know when and how to enroll,” Stamper said.

She did not say when that effort would begin.

But health care navigators, the organizations that help people sign up, have not pushed public awareness campaigns ahead of the change.

Cara Stewart, a health law fellow at the Kentucky Equal Justice Center, is also Kynector who helps people enroll. She said her group has held off from doing outreach because of uncertainty around the change. Kentucky still has to meet certain federal requirements to stop using Kynect for enrollment and join the national system.

“This time last year we were doing multiple events a week. You ramp up your outreach with back-to-school — in August — and here we are at the end of September, and we can’t really do anything,” Stewart said. “Even if you keep benefits in place, if you move the door and don’t tell people where the door is, it doesn’t mean much.”

Costs, Benefits to Federal System

Tonia Wooton, who works with Community Action of Southern Kentucky to help enroll consumers, said the process for signing people up would be a little different this year.

Instead of filling out an application for an enrollee, she’ll only be able to help them pick a plan, she said, HealthCare.gov rules require the applicant to complete enrollment. She also won’t be able to access enrollees’ eligibility processing once it’s submitted to HealthCare.gov.

“If someone calls me and asks ‘What’s going on with my case?,’ I can’t pull that information up anymore,” Wooton said.

Most questions were around whether and what level of payment assistance they’d receive, she said.

Kynect was funded through a 2 percent provider tax on revenues created in 2000 to fund KY Access, which was the original health insurance program offered by the state to people who had a hard time getting an individual plan. In 2014, as Medicaid was expanded and more people gained access through the state exchange, KY Access was dismantled. The 2 percent tax was kept to pay for Kynect.

Even with the dismantling of Kynect and the move to Healthcare.gov, the tax still exists, though there is talk among legislators of repealing it.

Insurers operating in Kentucky would have to pay 1.5 percent of the premiums they charge to use the federal system. There’s been conflicting information about how much Kentucky would pay in one-time costs do dismantle Kynect. Beshear put it at $23 million, while Bevin’s administration says $11 million.

Advocates are also concerned about using HealthCare.gov to determine whether a person is eligible for the marketplace or would qualify for Medicaid. At present, Kynect makes that determination. But such eligibility information will now be held by HealthCare.gov, and they’ll send Kentucky officials information on those who qualify for Medicaid.

“Every time you have a handoff there’s the potential for people to fall through the cracks,” said Joel Ario, a health care consultant at Manatt Health Solutions and former insurance commissioner of the Pennsylvania Department of Insurance.

But, he said, there are also benefits: HealthCare.gov is rolling out a mobile app and has a provider directory to help people choose a plan.

Kentucky will also keep some of its responsibility with marketplace exchanges by continuing to negotiate exchange plan benefits and costs. This means there will be more of a chance that insurers keep offering benefits, according to Ario.

“If you look at states where they’ve had problems with only one insurer, they’re almost all federal marketplace states where the state hasn’t been involved with working with insurers,” Ario said.

The Bevin administration declined to make state officials available to discuss the changes in further detail.

This story has been updated. 

Lisa Gillespie is WFPL's Health and Innovation Reporter.