I’m Medicaid-Eligible? But I Already Have Blue Cross!

Louisiana is extending Medicaid coverage this month to about 400,000 people with incomes below 138% of the Federal Poverty Level, or FPL (that’s about $16,400 a year for a single person or around $33,400 for a family of four). For most folks, this Medicaid coverage will take effect July 1, 2016, which is just a few weeks away.

I believe between 20,000 and 30,000 of these folks are current Blue Cross customers who purchased coverage from www.healthcare.gov and are receiving federal assistance with their premiums and cost sharing (like deductibles).

Unfortunately, according to federal rules, once you know you are Medicaid-eligible, you’re no longer eligible for assistance from www.healthcare.gov to help you buy Blue Cross insurance. In this case, Medicaid trumps www.healthcare.gov. Continuing to take the money AFTER your Medicaid start date could result in some stiff tax penalties (among other things).

People who believe they are Medicaid-eligible can go today and apply on www.healthy.la.gov for Medicaid coverage that begins July 1.

The Louisiana Department of Health and Hospitals (DHH) is trying to enroll as many people as quickly as they can in Medicaid coverage, as many of them have no health insurance at all. They are looking at household income information in three different state databases and sending Medicaid letters to people who fit a certain profile. If you are:

1. Getting Supplemental Nutrition Assistance Program (SNAP, or “food stamps”) benefits and your income is below 138% of FPL, you will probably be enrolled into Medicaid and will receive a letter indicating that is the case.
2. Enrolled in the Greater New Orleans Community Health Connection (GNOCHC) program, a no-cost health insurance program for residents of Orleans, Jefferson, St. Bernard and Plaquemines parishes, and your income is below 138% of FPL, you will also likely get a letter (they are already out there) telling you to expect Medicaid eligibility on July 1.
3. Enrolled in the Take Charge Plus program, which provides free family planning coverage to eligible Louisianians, and your income is below 138% of FPL, you will be auto-enrolled into the Medicaid program in the next few weeks.

If you fit any of the above categories and you are a Blue Cross customer already, be sure to contact your agent, or www.healthcare.gov at 1-800-318-2596 if you don’t have an agent, as soon as you receive a Medicaid letter to discuss your options. It’s important that you don’t have any gaps in your coverage, and likewise that you stop taking premium and cost sharing assistance once Medicaid begins.

People who believe they are Medicaid-eligible can go today and apply on www.healthy.la.gov for Medicaid coverage that begins July 1.

 … (T)he burden of making sure you are not accepting federal assistance that you shouldn’t be using through www.healthcare.gov falls squarely on your shoulders.

In addition to the tens of thousands of Blue Cross individual customers who will fall into the “Medicaid-eligible” zone, we know there are tens of thousands MORE Blue Cross customers who currently get their insurance through an employer and will also be Medicaid-eligible. If you are one of them, before you switch any coverage, be sure to contact your employer’s Human Resources department to make sure you know your rights under both your employer’s plan and Medicaid. You can always contact www.healthcare.gov if your employer is too small to have an HR department.

Ultimately, any policy purchased through www.healthcare.gov, with the assistance of an agent or not, can only be modified or changed through www.healthcare.gov. At this time, I don’t see any processes in place to automatically cancel or adjust coverage for the newly Medicaid-eligible, but we will certainly update this information if that changes.

This means the burden of making sure you are not accepting federal assistance that you shouldn’t be using through www.healthcare.gov falls squarely on your shoulders. It does not appear that www.healthcare.gov or DHH will do anything to make sure you are not accepting money from the federal government in error. You have to take action.

Remember, if you are a Blue Cross customer and get a letter saying that you are Medicaid-eligible, contact your agent immediately or www.healthcare.gov at 1-800-318-2596, if you don’t have an agent.

We’re watching as expansion and enrollment go forward. It’s an exciting time in Louisiana healthcare, with hundreds of thousands of people receiving access to coverage, many for the first time in their lives. I just want to make sure that no Blue Cross customer ends up being punished for accepting federal assistance after eligibility has ended.