State Punts Medicaid Enrollment to Federal Website with Cover Oregon

State official Tina Edlund told legislators Monday that the state has given up trying to conduct most enrollments for the Oregon Health Plan itself. Like the private insurance consumers, low-income Oregonians will be directed to healthcare.gov to get coverage. Cover Oregon Director Aaron Patnode also explained that a recent error means consumers with certain subsidized insurance plans will owe about $20 more than they were first told.

The state is backing away from any involvement with new Obamacare health enrollments come Nov. 15, with former health authority director Tina Edlund telling legislators Monday that the federal online portal -- healthcare.gov -- will be in charge of new Medicaid enrollments as well as enrollments for subsidized insurance that had been the responsibility of Cover Oregon.

The state will host a website -- oregonhealthcare.gov -- that automatically redirects consumers who either want a subsidized individual health insurance plan or the Oregon Health Plan, to healthcare.gov, as the state gives up conducting its own enrollment for either population.

For people who are already on the Oregon Health Plan, the state will conduct a separate redetermination process through the U.S. Mail.

Edlund, who was assigned by Gov. John Kitzhaber to head up the transitioning of the Medicaid enrollment back to the health authority, said a lack of cooperation with a key “vendor” -- i.e., Oracle -- has prevented the state from conducting the enrollment itself, as it had planned.

“Development has stopped for anything that’s reliant on Oracle,” Edlund said.

Her presentation Monday was a subtle shift from her earlier reports, when it was noted that the British consulting giant Deloitte would work to salvage the Oracle technology for use with the Medicaid enrollment. In early August, she downshifted the scope of its work and said for November, Medicaid applicants would continue to rely on a hybrid process where they would have to wait to find out if they were approved after submitting a PDF online.

Now even that will not happen, with the federal government filling in where the state has fallen flat. Since Edlund’s earlier announcement, Oracle and the state have unveiled dueling lawsuits in court, each side blaming the other for the worst information technology debacle in state history.

But punting this responsibility to healthcare.gov should mean less hassle for consumers. Instead of worrying if they qualify for a private insurance subsidy or the Oregon Health Plan, the federal site will direct them to the appropriate place. New Oregon Health Plan members will also be able to enroll in one sitting with working electronic technology, without having to sign up with a PDF and wait to receive approval in the U.S. Mail -- as they would have had with the plan Edlund mentioned last month.

The PDF hybrid system will remain in place for certain vulnerable populations such as refugees and pregnant women who are eligible for the Oregon Health Plan.

Edlund said Monday that the state will still assume responsibility for Medicaid enrollment in the future, and healthcare.gov would only enroll people for the 2015 plan year, starting Nov. 15. The state plans to bypass Oracle by ordering technology from Utah and Texas, but such a shift will delay the state’s ability to handle the Medicaid enrollment by itself.

Subsidy Error Only About $20 a Consumer

Cover Oregon Director Aaron Patnode also explained a mistake the exchange made in calculating insurance premiums. Tax subsidies are only available for so-called “essential health benefits,” as defined by the Affordable Care Act. They cannot be applied toward other services a health plan might cover, such as chiropractic care and acupuncture.

The exchange had been mistakenly applying the subsidies toward services that the federal government refuses to pay for, resulting in Cover Oregon charging consumers less than they should. But because these services amount to only about ½ a percent of the cost of a health plan, consumers have only been underpaying by about $2 a month.

Doing their best to be attentive to their constituents’ needs in the wake of even more Cover Oregon troubles, legislators grilled Patnode on the subject. Sen. Chip Shields, D-Portland, said the state should fill in the gap for these consumers, which Patnode said amounted to about $9,500 total for about 800 consumers. He added that his organization had only finished determining the discrepancy for 92 percent of consumers.

“We as the Legislature and the state should be making these people whole rather than make them pay for the mistake,” Shields said.

But in the grand scheme of things, the error -- averaging a little more than $20 for an entire year per policyholder -- is a trifle compared to the wildly unpredictable subsidy amount each consumer will get to claim come tax time. Some taxpayers who purchased a subsidized individual insurance plan from Cover Oregon could easily end up paying 10 times that because of the rough way subsidies were estimated.

Figuring out the precise subsidy will be a huge headache for accountants and the Internal Revenue Service, since each taxpayer’s actual adjusted gross income could be quite different than the back-of-the-envelope estimate that consumers were asked to provide when they signed up for coverage in late 2013.

Those estimates were based on no more than a consumer’s educated guess, gathered from their monthly income at the time or their annual income from 2012. If the consumer guessed high, they’ll get a greater rebate from their tax return after April 15. If they guessed low, they could owe the IRS a significant sum of cash.

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