The state launched a $95 million electronic overhaul of the Medicaid eligibility system Tuesday in anticipation of thousands of new enrollees joining under the federal health insurance law, known as Obamacare.
For the first time, residents are able to apply online for Medicaid, the government health insurance program for the poor. Applying online for other public assistance programs, such as welfare and food stamps, eventually will also be available as the electronic system is fully implemented.
The state Department of Human Services will also use new technology to determine eligibility for subsidies and tax credits for people buying coverage on the health insurance exchange known as the Hawaii Health Connector. The Connector’s online marketplace didn’t open for enrollment Tuesday because of a software problem, but the new Medicaid site began enrollment as planned, DHS said.
Until Tuesday, Medicaid applications were paper-based and required manual input into the state’s antiquated computer databases. The new system is expected to simplify and speed enrollment for Medicaid and other government social services programs.
Residents representing more than 600,000 cases will eventually benefit from electronic enrollment once it is integrated through the next two to three years, said DHS Director Patricia McManaman.
"This system will aid and benefit all families," McManaman said. "As we proceed over the next six months, the public will see enhancements in the system. For Medicaid and also for us as a department, we will be leveraging the technology to other divisions to our different services. These systems are going to do much more than allow people to apply and have eligibility determination. It also is going to assist us with case management functions. We hope the system will replace paper files and that we will become a paperless organization."
DHS said it leveraged federal dollars available under President Barack Obama’s signature health care law to improve the Medicaid enrollment system and build a state data hub, where income information will be verified.
Consumers will be able to fill out a single streamlined application for both Medicaid and the Connector and will be routed to the program fitting their income. To qualify for Medicaid, adults (with the exception of pregnant women) must earn no more than 138 percent of the poverty level ($15,414 for individuals, $31,809 for a family of four). Consumers must be determined ineligible for Medicaid in order to apply for subsidized insurance on the Connector.
Consumers can earn up to 400 percent of the Hawaii poverty level ($52,920 for a single person and $108,360 for a family of four) to qualify for tax credits.
The applications will be cross-checked by both state and federal data hubs simultaneously being built throughout the nation. Those hubs, linked with the Internal Revenue Service and other federal agencies, will verify citizenship, income and other information.
The state ultimately wants to be able to determine Medicaid eligibility in real time, but next-day determination is the likelihood in the short term. DHS currently has up to 45 days to determine whether an applicant qualifies for public health insurance.
Medicaid is being expanded under the federal Patient Protection and Affordable Care Act, intended to transform the health insurance industry and provide affordable coverage to all. The $2,000 asset limit for Medicaid is no longer a factor in determining eligibility.
"Just by changing the criteria there’s decreased requirement for documentation," said Kenny Fink, administrator for DHS’ Med-Quest Division. "When we apply the eligibility change, from an income perspective we’re already at an expanded level."
Roughly half of the estimated 48,000 residents expected to join Medicaid’s rolls will qualify due to the removing of the asset limit. The other half will come from what DHS is calling the "woodwork effect," people who were already eligible and hadn’t applied, but will do so now that the health reform law requires most Americans be covered by Jan. 1 or face penalties of $95 next year, or 1 percent of income, whichever is greater. The penalties rise each year thereafter.
Current Medicaid/Quest beneficiaries do not need to re-enroll in the new electronic system. People also can still apply for Medicaid using paper forms, by phone at 877-628-5076 or online at mybenefits.hawaii.gov.
———
ON THE NET
» To apply for insurance on the exchange, go to www.hawaiihealthconnector.com or call the Connector call center at 877-628-5076.
