By Benjamin Geyerhahn and Chelsea Sprayregen
A lesser-known provision of the Affordable Care Act provided states with funding to modernize woefully outdated Medicaid application and eligibility determination systems. Whereas the federal government previously paid for 50 percent of these improvements, the ACA bumped that rate up to a staggering 90 percent.
Some states used this funding to transform their programs in remarkable ways. Others missed the mark. The most common mistake: States failed to understand the modern digital divide.
This mistake has implications for Medicaid applicants and recipients and those who employ them. Many employers of low-income workers have struggled to navigate the ACA and find the most fiscally responsible way to help their employees. Medicaid enrollment is a solution for these leaders, but the complexity of the enrollment system makes it a solution with significant challenges.
When states began making system renovations, they focused on how to simplify or modernize their outdated systems and lost sight of how to make the system easier or more accessible for the intended audience. In doing so, those states failed to recognize the limitations of their low-income audience in this digital age.
For example, New York used its money to “go green” — essentially moving its entire application process online in an attempt to reduce waste. But assuming that the majority of applicants have reliable access to the Internet at home (not to mention tools such as scanners and photocopiers that are often needed to verify income, immigration status, etc.) was unrealistic, and it ignored the financial realities of many hardworking New Yorkers. Now, New Yorkers who lack the tools they need to fill out online applications are forced to rely on unsecure public devices or seek out in-person assistance.
What’s more, research shows that 43 percent of people with annual incomes below $30,000 — most of whom qualify for some public benefits — do the majority of their Internet browsing via smartphones. But only mobile-responsive websites or specially developed apps are truly accessible to smartphone users. While many states made changes to their Medicaid websites, virtually none of them were redesigned with mobile technology and accessibility in mind.
In the end, it became obvious that many of the “modernizations” made to state programs were based more on middle-class values than low-income needs. In those states, the renovations completely missed the mark on helping the intended and important segment of the audience and often made the application and eligibility determination process even more difficult.
This not only increases healthcare costs for business leaders, but also poses problems for employees. Because company plans are more expensive with fewer benefits than Medicaid, low-income employees will likely find it difficult to pay for the coverage and any doctor’s visits, procedures and medicines.
However, if business leaders help their low-income employees apply for and transition over to Medicaid, it’s a win-win. Eligible employees and their families will gain access to comprehensive coverage at little to no out-of-pocket cost. In turn, this produces healthier, more focused, reliable and productive employees. And employers will save significantly on healthcare expenses.
1. Work with the best. A third-party enroller can be a valuable investment for business leaders, especially those with a large population of low-income employees. These experts will guide employees through the complicated application processes for every qualifying public benefit. Some companies will even send enrollers to the workplace so business leaders can bypass many of the technological issues causing the digital divide.
2. Cater to employees’ technological preferences. The trend is to put all health insurance information and enrollment online, but that simply won’t work for low-income employees. Understanding their needs and delivering benefits in a way that meets those needs pays dividends. A tech company or a law firm can ask its employees to complete complex forms online, but a manufacturer would benefit from using a dedicated call center with professionals who can walk employees through their options.
3. Create a judgment-free environment. By design, the ACA expanded Medicaid to cover working adults. Helping your employees access this program is no different than giving your higher-paid employees access to a private plan or a 401(k). While most employees will be grateful for the chance to get help at work, you can lead by example and make it clear that there’s no judgment or stigma when your hardworking employees qualify for public benefits. This will ensure that all employees feel comfortable taking advantage of the help you’re offering.
The federally sponsored “modernization” of state Medicaid processes revealed that many government agencies are still unfamiliar with the limitations of the low-income population. However, employers can learn from the setbacks of those agencies. By making more calculated changes to business practices, business leaders can improve communication and offer useful assistance to eligible employees as they transition to Medicaid.
Image credit: Flickr/japanexperterna.se
Benjamin Geyerhahn is an experienced entrepreneur, a healthcare policy expert, and a member of New York Governor Andrew Cuomo’s Health Benefit Exchange Regional Advisory Committee. He is the founder and CEO of BeneStream, which uses a combination of technology and a multilingual call center to guide employers and employees through the Medicaid enrollment process.
This article was co-authored by Chelsea Sprayregen, director of policy and product development at BeneStream. Before joining the team in 2013, Chelsea worked as a field organizer for President Barack Obama’s reelection campaign. Now, she’s responsible for the delivery of BeneStream’s benefits enrollment service.