Caldwell County agencies prepare for start of Obamacare

Sep. 29, 2013 @ 08:50 AM

While opponents of the president's health care reform law fight in Washington to shut down the government if they can't eliminate funding to implement the law, local officials are gearing up for Oct. 1, when people can begin enrolling in health care plans.

Plans purchased from the Health Insurance Marketplace, an online system to help people examine their health care options, are set to take effect Jan. 1, 2014.

The Caldwell County Health Department, West Caldwell Health Council, Caldwell County Department of Social Service and Caldwell Memorial Hospital have all been training staff to assist with new applications and enrollees.

West Caldwell Health Council has been designated by the Centers for Medicare and Medicaid Services as the certified application counselor organization for Caldwell County, serving as the main place for those in the county to look for help enrolling in the Marketplace. Currently, the only certified application counselor in the county is Wanda Ellis, hired in August by the West Caldwell Health Council as its outreach and enrollment coordinator specifically to help consumers navigate the Patient Protection and Affordable Care Act, also known as Obamacare.

"I am a totally unbiased counselor," Ellis said. "I'll sit them down, go through the portal and help them understand the process. I’m more of an advocate to the community."

In the coming months, other employees at West Caldwell Health will be training to become certified counselors, a process that takes about 30 days, Ellis said. The council has set a goal of enrolling 2,500 people by the end of the open enrollment period on March 31, 2014.

The Caldwell County Health Department will be affected a little differently than other organizations, because the health department is itself a health care provider, said health director Denise Michaud.

"Our role as a health department is to hopefully be a place where people can come while they're waiting for services and do online applications," Michaud said, adding that the county has been working with clinics such as Helping Hands Clinic in Lenoir to set up kiosks where clients can fill out online applications.

At Caldwell Memorial, David Horn, vice president of business development at the hospital, “We’ve been training members of our staff on how to assist people with the enrollment process, and how to encourage people to seek information and to understand the process.”

The Caldwell County Department of Social Services is mainly preparing its staff to accept new cases of Medicaid that come as people discover they are eligibile for it through the application process for the Marketplace, said Will Wakefield, adult and family support services program administrator.

"At same time, we're trying to become familiar with navigators and resources so that when people aren’t eligible for Medicaid we can push people to those resources," Wakefield said.

Helping Hands Clinic, which provides free health care for 2,500 of the nearly 14,000 uninsured individuals in Caldwell County, has been working with the health department to set up a kiosk and computer at the clinic for clients to fill out the necessary paperwork and explore their options.

But executive director Lilly Skok Bunch said less than 25 percent of the clinic's clients are expected to be eligible for subsidized insurance plans available through the Marketplace, because roughly 75 percent of Helping Hands' clients earn 100 percent of the federal poverty level or below, Bunch said, and further exemptions, like one that exempts consumers from the program if the cost of health insurance is more than 8 percent of their income, disqualifies more of Helping Hands' patients.

According to ACA guidelines, only those uninsured individuals whose income is between 134 and 400 percent of the federal poverty level, which is $11,490 for an individual and $23,550 for a family of four, will be eligible for purchasing subsidized insurance plans on the Marketplace.

Since North Carolina declined the federal expansion to Medicaid that came as part of the ACA, North Carolinians will see no change in eligibility for Medicaid, but consumers can find out their eligibility status through the Marketplace portal.

The federal program will provide subsidies on a sliding scale, depending on income, that will average more than $5,500 per family. To qualify for subsidies, annual wages must range from $11,490 to $45,960 a year for an individual, and from $23,550 to $94,200 a year for a family of four.

The law calls for a fine of $95, or 1 percent of annual pay, whichever is greater, for those who fail to get coverage. The fine will increase in subsequent years and will be taken out of tax refunds.