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2019|08

The Family Glitch

Why do 1,300 people still depend on the Washtenaw Health Plan?

by Ilene Wolff

From the February, 2015 issue

The Patient Protection and Affordable Care Act--aka Obamacare--should have made the county's health insurance plan obsolete. Created in 2002 to insure residents who couldn't afford coverage but weren't poor enough to qualify for Medicaid, it enrolled more than 8,000 people in October 2013.

Though Obamacare moved most people out of those traps, it isn't working for everyone. Krista Nordberg, WHP's director of enrollment and advocacy, says one reason so many people remain on the county plan is something called the "family glitch."

The glitch hits working families--families where one member qualifies for coverage from an employer but earns only enough to make an "employee contribution" for their own insurance--not the much larger premium that would cover the entire family. Unless they're poor enough to qualify for Medicaid, they're out of luck: because one member has employer-provided insurance, the family is ineligible for an ACA subsidy. Faced with a "ginormous increase" in premiums if they leave WHP, says Nordberg, these families are staying put.

Happily, they're the exceptions: since October 2013, approximately 6,700 county residents have left WHP. About 1,100 became eligible for subsidies to buy private insurance via HealthCare.gov. About 1,600 didn't respond to invitations to come in to discuss coverage options and were dropped from the rolls. And almost 4,000 are now covered by the state's expanded Medicaid program.

"For lots of people, it went surprisingly easy" to enroll in Medicaid, says Nordberg. "We did the applications, they were approved right away, and that's it."

Candice Starks is one former WHP enrollee who made the switch to Medicaid. Starks, of Ypsilanti, is thankful for health coverage in part because she has type 2 diabetes, which she's been trying to control through healthy eating.

"I have to count my blessings," says Starks. "I have pretty good health for being sixty-four years old."

One of Starks' blessings is that she's had no problem keeping Medicaid coverage.

Others are not so blessed: some people newly covered by Medicaid have had their insurance terminated for no apparent

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reason. The lapse usually coincides with a change or update in coverage for other safety net programs, such as recertifying for food assistance.

"We see a lot of problems with people getting coverage for a few months, and then they lose it," says Nordberg. "So we do a whole lot of advocacy with the Department of Community Health."

Nordberg pins blame for the recurring problem on the state's computer system. The Michigan Department of Community Health did not give an explanation.

Beyond the seemingly endless bureaucracy, however, there is some good news: though doctors often criticize Medicaid's low payments, patients like Starks who are newly covered by state program are finding, or keeping, caregivers.

"Anybody that was on the Washtenaw Health Plan was already with a doctor's office that accepted Medicaid," Nordberg explains. "So access seems to be going fine."

A December study by the U-M Center for Healthcare Research & Transformation supports Nordberg's observation. Of about 300 primary care doctors responding to a survey, 64 percent said they're taking new Medicaid patients.

Though Obamacare has yet to render WHP obsolete, Nordberg focuses on the positive. "At least we're left feeling pretty good because we got our people where they needed to go," she says.    

[Originally published in February, 2015.]