Two Missouri health care organizations that have received more than $1.7 million total in federal grants to promote the Affordable Care Act this fall have begun to recruit and will soon begin training a corps of insurance "navigators" across the state.
Navigators will help people who need guidance shopping for and enrolling in plans in the health insurance marketplace. Navigators, however, will have to explain to some uninsured Missourians that they do not qualify for tax breaks in the marketplace and are still not eligible for Medicaid because the Missouri General Assembly did not act to expand coverage in the last legislative session.
According to census data, there were more than 800,000 uninsured residents of Missouri in 2011.
"We need to get out there - we have a lot of people to reach," said Catherine Edwards, executive director of the Missouri Association of Area Agencies on Aging, one of the two grant-funded organizations that is disbursing the money to smaller, local groups.
The other organization in Missouri is Columbia-based Primaris Healthcare Business Solutions. Both organizations say they're tapping into their existing networks of community organizations and training counselors to answer questions about new insurance options. They'll also enroll people, organize outreach events and pool best practices across the state.
The grants are part of an effort to raise awareness about the options available to people once enrollment in the new federal health insurance marketplace begins Oct. 1. The Obama administration awarded $67 million to 105 groups in 34 states on Aug. 15.
At an all-day conference in Columbia on Tuesday, organized by the Missouri Foundation for Health and other health care groups, a cadre of experts and professional health care advocates met with activists to discuss strategies for expanding coverage to Missouri's uninsured through the federal marketplace.
Primaris and the Agencies on Aging received final approval for their scope of work from the federal government earlier this week and planned to begin a 20-hour online training program for navigators as soon they are recruited.
Jeremy Milarsky, navigator grant program manager for Primaris, said the company's grant of just more than $1 million would fund about 55 navigators, who will work within Primaris and 10 other groups around the state. Primaris plans to act as a clearinghouse of "success stories" and distribute material about best practices for reaching the uninsured.
"Our mission is to help people understand the system," Milarsky said.
With 10 local Area Agencies on Aging, 200 senior centers and a variety of community programs across the state, Edwards said the organization would allow its sister groups to work within the infrastructure they have developed through their work with Medicare enrollment. She said the group's $750,000 grant would pay for 13 navigators, some of whom would be existing counselors in the agencies' network.
At the conference, Stephene Moore, regional director of the Department of Health and Human Services, said rates for the available plans - separated into bronze, silver and gold options - would be publicly available by the end of September and that people will be able to enroll in plans beginning Oct. 1. Coverage under plans sold in the marketplace will begin Jan. 1.
In the gap
Although Missouri health care advocates are excited about the opening of enrollment for the marketplace, the specter of Medicaid expansion still looms large.
Since the legislature did not act to expand Medicaid to new standards set out in the Affordable Care Act in the last legislative session, Missouri will forgo billions of federal dollars, beginning Jan. 1.
Under the new health care law, the federal government will pay for 100 percent of the cost of expanded Medicaid for three years in states that increased eligibility to 138 percent of the federal poverty line. By 2020, the federal government would cover 90 percent of the costs, and the state would cover the remainder.
Although the Missouri legislature voted against the expansion in the last session, House Speaker Tim Jones in June announced the creation of two committees that would study Medicaid reform. The first committee, which included citizen appointees, traveled the state in July and August and heard from citizens at public forums. A second committee composed only of legislators will begin meeting this fall to develop specifics that could go before the legislature.
According to an MU study published in November, if Missouri expanded Medicaid,Â the federal government would contribute $8.2 billion to expansion while the state would have to contribute about $332 million from 2014 to 2020. It estimates that in 2014, more than 218,000 Missourians would become eligible if the state expanded Medicaid.
Until the state legislature acts to meet the new Medicaid standards, Missourians who make too much money to qualify for the state's current system but not enough money to qualify for tax credits in the new federal exchange won't have new insurance options.
"Until Medicaid transformation happens, there will be a group of people that fall into a gap," Edwards said. "All we'll be able to do is explain to them what is available to them now. That's really all we can do."
The navigators will explain to people who fall into the coverage gap why they do not qualify for tax credits through the marketplace and tell them they can share their stories through a program run by St. Louis University.
Milarsky said federal officials told Primaris to inform people that fall into the coverage gap that applying to Medicaid and sharing their personal stories was an option regardless of income.
Reps. Chris Kelly, D-Columbia, and Stephen Webber, D-Columbia, have both been assigned to the committee that hopes to develop a consensus plan this fall that would "transform and expand" Medicaid. The committee hopes to introduce a bill when the legislature begins its session in the new year.
Webber said it remains unclear what specific changes to Medicaid would make it possible for Republicans to agree to expansion, but to him the fix is clear.
"They need to find a way they can get on board with the federal law," Webber said Thursday night at a forum in Jefferson City.
"I think there's still a chance, and as long as there is still a chance, we've got to work to make it happen," he said.
Rep. Caleb Rowden, R-Columbia, served on the committee that traveled the state and heard from citizens about their health care experiences and views on Medicaid expansion. He said the vast majority of people who testified were in favor of expansion.
The challenge before the committee that will work on legislation is achieving reforms that Republicans can accept while also meeting the federal requirements for receiving additional Medicaid funds. Rowden said reforms in cost savings, efficiency, and checks and balances within the system are all possible.
The goal is to find "the middle ground between what the feds will grant us and what the Republicans will vote for," Rowden said.