Two major vehicles for affordable health care will begin general enrollment Thursday in Virginia: Medicaid and the Affordable Care Act.
Insurers and local agencies are racing to add staff and get the word out about updates to the state’s Medicaid program, which provides care to low-income adults and children, and local ACA plans, which are available to most people who do not receive benefits from an employer.
This is the state’s first year of expanded Medicaid, which is expected to extend care to as many as 400,000 people. It’s also the first year without a federal mandate that required most people to have health insurance or face a penalty, which may tempt Central Virginians who saw sky-high premiums in 2018 to leave the marketplace altogether.
Medicaid enrollment will take place even though the state is still waiting on approval of a waiver proposal that would add a work requirement, according to Christina Nuckols, a spokesman for the Virginia Department of Medical Assistance Services. The process could take a year or two. If approved, the requirement would ask non-disabled adults to work, be in school, or do community service in order to receive care, and add small premiums. Until then, income is the main requirement for eligibility; single adults making up to $16,754 a year or a family of three making up to $28,677 qualify.
“Our budget does call for services for the newly-eligible to begin in January 2019,” she said.
According to a City of Charlottesville memo, 2,100 adults in city limits will be newly eligible for Medicaid; the city’s social services department is partnering with the University of Virginia Medical Center, Region Ten Community Service Board, United Way, the Free Clinic and others to spread the word about expansion, new income limit requirements and encouraging people who may have been denied coverage in the past to reapply.
The state is also helping local social services offices who need to hire new staff to meet additional demand. Charlottesville received funding to add two benefits programs specialists and retain a part-time retiree, according to city spokesman Brian Wheeler.
Phyllis Savides, director of Albemarle County’s Department of Social Services, said the county has hired a staff member to help walk-ins find assistance and fill out online applications. Two work stations will be available near the department’s lobby for people to apply for benefits online and by phone. The department has also hired additional benefits specialists.
Medicaid is the service that pays for coverage, but when people enroll they will have to choose from among six providers in the state who will actually offer care: Aetna, Anthem HealthKeepers, Magellan, Optima Family Care, UnitedHealthcare and Virginia Premier. The providers are available in each area of the state, and while each offer the same essential benefits, they may have slight differences in premiums and co-pay options.
If eligible Virginians enroll but do not pick a provider within 90 days, Nuckols said, they will be assigned one. Consumers can shop plans and see if they are eligible for care at coverva.org.
As well, Virginians who earn above 139 percent of the poverty level but don’t get company benefits can continue to choose from plans on the individual marketplace. Last year, Optima Health offered the only plans in Charlottesville — at substantial price hikes.
Under public pressure, Optima proposed slightly lower premiums for the Charlottesville area for 2019. A late request to further lower rates after Anthem HealthKeepers announced re-entry to the area was denied by state regulators.
Dennis Matheis, Optima’s president, said he is disappointed that the commission did not allow Optima to lower rates; he said that up until the filing deadline, the bureau seemed amenable to a flexible deadline while Optima considered its options.
“But that’s water under the bridge now,” he said.
The company has created a new plan, called OptimaFit Select, to address what it called a signification driver of the 2018 price hikes — the University of Virginia Medical Center’s cost of care. Select plans will include providers at Sentara facilities, Eastern Virginia Medical School, Children’s Hospital of the King’s Daughters, Tidewater Physicians Multispecialty Group, but will not include UVa doctors, according to a flyer provided by the company.
“It was built in mind to offer more [price] options to consumers, and to that end we decided to limit the number of providers,” Matheis said.
The company’s broad-network Direct plan will still be offered and does include UVa providers, though at a much higher rate. UVa has pushed back against the characterization that its rates should have been a driver in price hikes.
The consumer group Charlottesville for Reasonable Health Insurance has lodged complaints with the Bureau of Insurance about Optima’s rate renewal letters, which they say do not give enough information about potential 2019 costs and auto-enrollment into Select plans.
Under guidance from the Centers for Medicare and Medicaid Services, Optima’s rate renewal letters are only required to calculate a customer’s possible 2019 monthly payment based on 2018 subsidies. However, because Anthem’s plans will become the new local benchmark plans, people who re-enroll in Optima plans will face higher out-of-pocket costs in 2019 — making an estimated monthly payment for those customers likely to be hundreds of dollars, not $0.
Matheis said Optima’s rate renewal letters are required to use certain language by CMS and he believes they are appropriately worded. He encouraged anyone who is not sure what possible subsidies or premium costs could be to go to healthcare.gov.
Ken Schrad, a spokesman for the state’s Bureau of Insurance, which regulates the industry, said CMS has told the bureau proper procedure is being followed for pushing current consumers to Select plans. He also said the bureau had reviewed renewal letters and felt they offered sufficient notice about the limitations of Select plan provider networks.
“The bureau continues to explore with Optima additional ways to enhance communication regarding total cost estimate concerns,” he said.
Current and prospective customers can also visit anthem.com for more information about local options and enrollment, according to an Anthem spokesman.