Monday, June 29, 2020

"Anyone without health insurance can apply now" -- way to keep it simple, NYSOH

I have criticized messaging on ACA exchanges that's likely to confuse the majority of people newly uninsured after being laid off in the current crisis.  The main problem is that the exchanges submerge information about Medicaid, which is likely to insure more than twice as many newly uninsured people as is the ACA marketplace for private plans. Many who are eligible for Medicaid are likely never to find that out on the exchange websites.

Having obsessed about this a bit (123), I was pleased to encounter a Twitter ad from the New York ACA exchange, New York State of Health, that IMO gets the messaging right:

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The text presents the right hierarchy of choices. Medicaid in New York is open to any citizen and some immigrants with incomes up to 138% of the Federal Poverty Level ($1468/month for an individual; $3013/month for a family of four). It has over 6 million enrollees. The Essential Plan, a Medicaid-like Basic Health Program established under the ACA, is open to state residents with incomes in the 138-200% FPL range, as well as to legally present noncitizens with incomes below 138% FPL who are subject to the "5-year-bar" against federal Medicaid funding. It has 813,000 current enrollees. Child Health Plus is New York's CHIP program, for children in families that earn too much to qualify for Medicaid. It's subsidized up to 400% FPL and available at full price at incomes above that level. It insures 433,000 children. The ACA marketplace sells Qualified Health Plans, subsidized at incomes from 200-400% FPL. It has 273,000 enrollees.

The short video only mentions the likelihood of finding coverage at "little or no cost" without getting into the weeds.

The message here can be kept simple in part because New York extended its emergency Special Enrollment Period for the ACA marketplace to July 15. Normally, enrollment in the private plan marketplace can only occur during an annual Open Enrollment period, which ended on Feb. 7 in New York.  In March, New York and 11 other state-based marketplace opened emergency SEPs in which any uninsured person could enroll. Information about these SEPs on state exchange home pages did not always make clear that the SEP applied only to marketplace enrollment, and that Medicaid enrollment was available year-round. Wisely, this ad avoids mention of SEPs, simply inviting all comers to "find out what you qualify for."

Unfortunately, the New York State of Health website suffers from the same overemphasis on marketplace plans that I've spotlighted on the Maryland, Colorado and California exchanges. While the home page message for "individuals and families" above the "get started" button does mention Medicaid and Child Health Plus, clicking that button brings up a screener tool surrounded by text that heavily emphasizes the marketplace, populated with questions almost wholly focused on the marketplace:

While the "estimate financial help" option should steer low income visitors to Medicaid or the Essential Plan or Child Plus as appropriate, it suffers from a flaw common to nearly all exchange screening tools: it prompts for annual income only. Eligibility for Medicaid and Child Health Plus is determined on the basis of current monthly income. The screener may not recognize Medicaid or Child Health Plus eligibility for a newly unemployed person who's earned substantial income year-to-date but now has monthly income that would qualify her or her children for those programs. Further, every question posed in the screening tool except "estimate financial help" is irrelevant to those who qualify for Medicaid, the Essential Plan or CHP -- that is, to the vast majority of visitors.

With tens of millions of Americans newly unemployed, and a substantial number of them in need of insurance, the ACA exchanges need to be a catch-all. The NYSOH ad recognizes that. The NYSOH website doesn't.

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