State, Federal Health Care Systems Won’t Initially Interact

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September 30, 2013 —

INDIANAPOLIS – Thousands of Hoosiers can use the new website starting Tuesday to try to find insurance plans that fit their needs.

But the new federal system won’t be tied directly to the state’s Medicaid plan – at least not for awhile – which means some people may have to fill out more than one application to figure out where they belong.

State officials are urging Hoosiers to check before moving forward with any applications. Clicking on one of three buttons – adults, pregnant women or children under 19 – will bring up income charts with links to websites and applications.

“Beginning the process by coming through the right door will be critical in helping Indiana residents move as efficiently as possible through the application and enrollment process,” said Jim Gavin, a spokesman for the Indiana Family and Social Services Administration.

“It will be helpful in mitigating against backlogs and duplications,” he said. “Especially at the outset, applying in the wrong place could lengthen the application process. We also want to direct people to the appropriate subject matter experts on state vs. federal programs.”

The state and federal health care programs are administered separately. The state has essentially two related programs – Medicaid, which provides largely free care to the poorest of adults, children in low-income families and people with disabilities, and the Healthy Indiana Plan, which provides low-cost insurance to lower-income adults.

The federal program going into effect on Tuesday is a marketplace – often referred to as an exchange – that is meant to help people who don’t quality for Medicaid and can’t buy insurance through their jobs and therefore need to purchase plans individually. Plans purchased through the exchange will take effect on Jan. 1.

Because the two systems are not yet integrated, applications filled out in one can’t be transferred to another. That means someone who goes to or calls 800-318-2596, completes an application and then is determined to be Medicaid eligible will need to apply separately with the state for services.

Similarly, the state won’t be able to transfer applications to the federal marketplace if someone is determined to be ineligible for Medicaid.

“At least in the first few weeks of federal open enrollment, there will be a delay in the actual transfer of data between the state and federal marketplace,” Gavin said, although he emphasized that no data will be lost.

“This underscores the importance of going through the self-screening process and knowing the best place to apply,” he said.

The two systems are expected to be linked later this year. State officials said they have completed their part of the work for integration but the marketplace system isn’t ready yet.

State officials expect the Medicaid system will see an uptick in calls as Hoosiers try to navigate the new health care landscape. The FSSA has contracted for an additional 150 people for its Medicaid and HIP call centers.

Lance Rhodes, director of FSSA’s Division of Family Resources, said the workers have been trained to handle newly revised Medicaid applications and are ready to take them over the phone, which the state had not been required to do previously.

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