Reform Update: Training lagging for counselors to help consumers use exchanges

Healthcare providers and community organizations across the country that have been designated as certified application counselors to help consumers enroll in health plans on the new state health insurance exchanges are still waiting for their staff to receive certification because of delays by state and federal officials.

“People have called who would be eligible to purchase private insurance,” said Sally Goodman, a health promotion associate with the Erie Family Health Center located on Chicago's near West Side. “Unfortunately, we don't have anyone currently who's qualified to help people enroll in the health insurance marketplace yet.”

Erie is one of a number of providers that said they were experiencing delays in assisting people with enrolling because they either were still waiting for staff members to complete training or were waiting for them to receive federal certification.

Certified application counselors are organizations that have designated staff members to help guide people through the online insurance marketplaces established under the Patient Protection and Affordable Care Act. CAC staff members are required by the federal government to undergo five hours of online training and pass an exam to become certified. Some states require counselors to receive additional training.

Some observers have blamed the delays on glitches on the federal government's training website that have unexpectedly lengthened the amount of times it takes to complete training. Other observers say the delay is due to additional certification requirements established by states where elected officials oppose the healthcare reform law.

The CMS reportedly has had an influx of applications from provider organizations and agencies looking to volunteer to become CAC sites, creating a backlog in processing applications. Further compounding the problem has been this week's shutdown of the federal government, which has forced federal agencies to operate with greatly reduced staff.

“We certainly have been concerned that there's not enough assistance available between the limited amount of navigator grants (another type of enrollment assistance organization), and the fact that we were sort of late in getting this concept of certified application counselor carved into regulation, moving forward on actually registering entities and getting the training up and running,” said Tricia Brooks, a senior fellow at Georgetown University's Center for Children and Families. “Even organizations that would traditionally be in good shape to provide assistance can't obviously start doing that until they're certified.”

Some CACs that have been certified have experienced other delays. Dorothy Bullard, chief care coordination officer for Mercy Community Healthcare in Franklin, Tenn., a certified application counselor organization for counties south of Nashville, said her group planned to have an event at its adult clinic on Wednesday but canceled it in order to have more time to do a test run of the sign-up process through the federal HealthCare.gov website.

“We weren't able to get on the system because of the demand on the system,” she said. The overloaded computer servers also prevented counselors from being able to provide assistance to some of the individuals coming in for help. Her group has rescheduled events at its clinic for mid-October.

Having trouble logging in to healthcare.gov? Have no fear. In response to opening-day technical glitches and heavy traffic to its insurance marketplace website, HHS posted data Tuesday afternoon showing available plans and premiums across the 36 states with federally facilitated insurance exchanges.

A total of 140 insurance issuers are offering 1,779 different insurance plans across the marketplace, according to the data.

HHS provided sample premiums for each plan, based on six different coverage scenarios: a child, a 27-year-old, a 50-year-old, a family with 30-year-old parents and two children, a 30-year-old single parent with two children, and a 40-year-old couple with no children.

Not surprisingly, the data showed wide variations in plan choice and premiums from one region of the country to another. Read more.

The decision by the 26 states not to expand Medicaid under the Patient Protection and Affordable Care Act will leave uninsured two-thirds of poor African-Americans and single mothers and more than half of the low-wage workers who do not have insurance, an analysis by the New York Times found. People who earn less than 100% of the federal poverty level in those 26 states will be left without insurance, while people with slightly higher incomes – between 100% and 138% of poverty – will be eligible for subsidized private coverage through the state insurance exchanges. Single adults in some states don't qualify for Medicaid under their state's rules unless they make as little as $11 a day. The Times reported that people seeking enrollment assistance for exchange and Medicaid coverage this week already are discovering this bitter twist.

The 26 states that have rejected the Medicaid expansion have about 68% of the nation's poor people, uninsured blacks and single mothers. About 60% of the country's uninsured working poor are in those states.

Follow Steven Ross Johnson on Twitter: @MHSjohnson