By Katie Kerwin McCrimmon
Simultaneously excited to buy health insurance and fearful of a cancer relapse, health advocate Donna Smith tried to start shopping on Colorado’s health exchange on the first day.
She soon struggled with computer glitches that prevented Smith and countless other hopeful customers from creating accounts in Colorado and on the federal exchange on Oct. 1.
Smith kept trying and a few days later, managed to create an account.
“I thought, ‘Oh, this is marvelous!’ ”
Connect for Health Colorado’s online system then asked Smith if she wanted to try to qualify for financial assistance. Why not? She knew she wouldn’t qualify for Medicaid, but thought she might receive a federal tax subsidy.
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The health exchange website then bumped her to Colorado’s Medicaid enrollment website, known as PEAK.
That’s when Smith began her trip into a black hole. Connect for Health Colorado customers who know they don’t qualify for Medicaid nonetheless must fill out an onerous, detailed application and get a denial for the government run, low-income insurance program before they can qualify for tax subsidies and buy health insurance on Colorado’s exchange. In some cases, customers are learning right away that they qualify for Medicaid or that they don’t. But a high percentage of customers — between 40 and 70 percent — are getting stuck and are not getting quick answers.
The clunky system has outraged health exchange board members who believe it is driving away customers and this week called it “odious and embarrassing.” (Click here to read ‘Odious, embarrassing’ system driving down health sign-ups.)
Medicaid managers declined to comment specifically on holdups in Smith’s case. Nor would they say how many people are failing to get immediate approvals or denials and are therefore having to wait as long as 45 days, like Smith. Altogether, Medicaid officials say 24,935 people were found to be eligible for Medicaid in October and will start getting coverage in January. In a typical month, about 30,000 people apply. That number grew to 40,486 with the launch of health reform in October.
Rachel Reiter, a spokeswoman for Colorado’s Medicaid agency, said workers are trying to handle applications as quickly as possible, but also must ensure accuracy.
“Applications are processed within the federally required time frames and we recognize the urgency of people wanting to know right now what if they qualify,” Reiter wrote in a written response to questions about the Medicaid application. “As good stewards of taxpayer dollars we must ensure that Coloradans are getting accurate determinations. We can’t do that without complete and accurate applications.”
So far, only 3,408 people bought insurance on Colorado’s exchange in October.
Smith would like to buy, but has been stuck without any answers since Oct. 8.
“It’s a nightmare, like you’re in the Twilight Zone with these folks,” Smith said. “You can’t tell us that in this day and age, this couldn’t have been anticipated and handled in a better way than this.”
A two-time cancer survivor, Smith is paying $875 a month for high-deductible individual health insurance through COBRA from her last job. She’s eager to qualify for a better plan and needs to see an oncologist. Now 58, she survived a bout with uterine cancer at age 45, then was treated two years ago for an unrelated cancer called Carcinoid Syndrome. She’s had tests showing that that cancer is returning and needs treatment. She wants to pick a new health plan and see doctors now that she knows she’ll be able to continue seeing them when new coverage is slated to start on Jan. 1.
“I’m having health concerns and I’m worried about this. So, too, are other people,” Smith said. “Just fix it so those of us who have a need get can coverage.
“It’s not like it snuck up on us,” said Smith, who supports the Affordable Care Act and wants health reform to go even further. As executive director for a small non-profit called Health Care for All Colorado, Smith has no health insurance through her job and pushes for a single-payer Medicare-style insurance for everyone.
In the meantime, however, Smith is eager to buy private health insurance and wants Obamacare to succeed.
“There are people who can be helped by some of the provisions of this law. People will be hurt if this is not being done well,” Smith said.
She has tried to get answers about the paralysis with her application, but friendly customer service agents merely tell her that she must wait as long as 45 days and that many other people are in her position. Smith wants some answers.
“When is it going to work and what are they doing to make it work?” said Smith.
- Connect for Health on the phone: 1-855-PLANS-4-YOU (1-855-752-6749)
- Questions about Medicaid applications: 1-800-221-3943
- Online: Connect for Health Colorado (mobile app will be available initially for Droid smart phones)
- Questions about Medicaid: Colorado.gov/Health
On top of long wait times, Smith worries that few people will have the patience or skills to fill out the seemingly endless Colorado Medicaid application.
A well-educated expert on health policy, Smith still struggled with the form and estimates it took her three hours over two days to complete.
“It’s a truly invasive amount of information, especially when you already know that you’re not going to qualify for Medicaid,” Smith said.
The form asks for details about financial assets including cars, homes, bank accounts and stock.
“I did the whole thing. It was several pages. I just kept filling things out and filling things out. I thought, ‘This is ridiculous,’ and I’m adept at filling out applications,” she said.
“I started it one day and I couldn’t believe I had to do this. So I called the navigators and they told me, ‘Yes, you have to do that. Then you have to give us a denial number, then we can walk you through how to get the insurance. There’s no other way to do this,’ ” Smith recalls agents telling her.
“So I went back on the second day. It took another hour, a total of about three hours.”
Smith had to take time to look up information on car registrations and bank accounts.
Finally she finished, expecting to get her denial number. Instead, she got a disappointing, inconclusive answer. The PEAK system told her that her application required further processing. She received a confirmation number and nothing more.
“I don’t know what could be so complex,” she said.
As Smith has tried to follow up, she’s also been frustrated by Connect for Health’s website. Once, she wanted to check on her progress and decided to hit the chat button to talk online with a customer service agent at the Colorado Springs call center.
“I got in the queue and it told me I have 10 minutes to wait. Then, you get to about 9 minutes and the clock reset. Then it went another 14 minutes and reset. I stayed there and just watched and after about 45 minutes, I gave up.”
Smith never got to chat and feels deflated about the messy launch of health reform here and across the country.
“I want this to work so people can get affordable coverage. I was excited about the process. I was thrilled.”
That excitement is long gone. Now Smith, who with her husband is moving from Castle Rock to Denver this weekend after suffering more than $5,000 in losses from Colorado’s September floods, is just waiting.