Tuesday, June 30, 2020

Washington's ACA exchange gets its priorities straight

I have criticized state-based ACA exchanges for submerging information about Medicaid, which is likely to insure about twice as many of the newly uninsured as the ACA marketplace.

Scratch that complaint for Washington' state's HealthPlanFinder!  The home page has its priorities right, if the messaging is still a little fuzzy:

Apple Health is the state's Medicaid program, as you'll learn if you click on it. That click will bring you to a page that links to the eligibility requirements. For individual adults, they're clear and clean, paired with a prompt to apply:
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Now, problems. First: that opening message has the advantage of brevity, but it doesn't distinguish between Medicaid and marketplace, which creates some confusion. Another look:
Free or low-cost Apple Health is available year-round and a Special Enrollment is available if you have certain life changes.
You might wonder: if Apple Health is available year-round, who needs a "Special Enrollment"? The answer: someone who earns too much to qualify for Apple Health and wants to enroll in private marketplace plan, for which enrollment must either occur during a short "open enrollment" season or be granted on an individual basis to those who undergo certain life changes, including loss of other coverage.  Not only is that unclear here -- it's unclear when you click through. The first paragraph on the next page doesn't make clear that we're dealing with something other than Apple Health:
A special enrollment period is a time outside the open enrollment period when you can sign up for coverage or shop for a new plan. Certain life changes or special circumstances may qualify you for a special enrollment period. For events that don’t qualify for a special enrollment period, you’ll need to wait for the next open enrollment period to sign up or shop for a new plan. When you apply or report a change through Washington Healthplanfinder, your health plan shopping experience will depend on your qualifying life event.
The next paragraph does reiterate that Apple Health enrollment is available year-round. But the alternative product to which the rules described above apply is not actually named.

The Apple Health eligibility page also has a problem. Above, we looked at the clear eligibility criteria for "individual adults." But there's another tab listing eligibility criteria for "Parents/Caretakers." And that program has extremely low income eligibility ceilings: $511/month for a single person, $658/month for a two-person household. Left unsaid: Parents are eligible under the much more liberal "individual adult" criteria -- up to $1468/month income for an individual, $1983 for a two-person household, etc. What if you click through to "Parents/Caretakers" (because you are one) and give up in despair?

Messaging for public health insurance programs is hard to get right because the layered and patchworked array of programs is so damned complicated. Yesterday I lauded this messaging from the New York ACA exchange, New York State of Health:
Anyone without health insurance can apply now thru #NYSOH. Enrollment is open for all NY State of Health Programs: Medicaid, Essential Plan, Child Health Plus and Qualified Health Plans. Find out what you qualify for by calling 1-855-355-5777 or visiting: http://on.ny.gov/2UoOKAk
Come one, come all, yes -- and the programs are listed in descending order of enrollment volume. A visitor from Mars, however - -or Taiwan, or Canada -- might wonder why four programs are listed, instead of, say, one. Why indeed?

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