Opinion: Choice Needed for Medicaid Families under Expansion


Two key components of the Affordable Care Act will roll out in 2014 with expanded Medicaid coverage for our lowest-income populations (if secured by the state Legislature this session) and insurance Exchanges offering subsidies to make health coverage more affordable for people with higher incomes. 

Washington state’s new health care insurance Exchange online portal, known as Washington  Healthplanfinder, will bring new enrollment and choice for many individuals and families to select a health plan for insurance coverage in 2014. Individuals and families enrolled in Medicaid, however, will not enjoy this same opportunity to choose a health plan that will fit their health care needs.

Unlike many other states, which allow Medicaid enrollees to choose a health plan when they enroll for coverage, Washington intends to automatically assign enrollees to a Medicaid health plan. Enrollees will be able to change their health plan assignment but only after receiving the initial assignment letter from the state.

Lack of choice will create problems, especially for families with parents eligible for coverage through the Exchange and children eligible for Medicaid. Because these families will not be able to select a health plan when they initially enroll, the parents will have to make an additional effort to keep their provider or ensure they can go to the same clinic as their children.

Parents may actually delay enrolling in coverage until they know which plan their children are assigned to, what other choice of health plans they have for their children, and which of those plans are also available to them in the individual Exchange marketplace.

The lack of Medicaid patient choice will dilute the purpose of Washington’s health care Exchange to provide accessible, affordable health insurance. The Exchange will provide competition for coverage options in the individual market, but the Health Care Authority would retain its role in allocating Medicaid patients to health plans.

Shutting Medicaid families and individuals out of choice creates an unequal process for some individuals that could potentially undermine successful outreach and enrollment efforts overall. Outreach for the Exchange emphasizes the shopping experience for consumers, but confusion will reign if people don’t get to actually shop for coverage.

Being able to choose your health plan is an important aspect of taking responsibility for your health care, whether you are on Medicaid or Exchange coverage. 

As Washington moves quickly toward open enrollment, legislators and advocates are voicing their concerns about the need to include choice for Medicaid families and individuals. While the state has cited infrastructure technology challenges for building in choice, it has the opportunity to take advantage of funding for system improvements designed to simplify enrollment.

The Health Care Authority could use federal funds they have already received for this purpose or apply for additional funds. The State Legislature should also budget dollars to correct this unfair oversight. Adjustments should be made before open enrollment begins on October 1, 2013.

Allowing all individuals to select the health plan of their choice during initial enrollment, regardless of their program eligibility, is fundamental to realizing the goals of health care reform and equity in health care choices.

Ms. Firth is the Director of Public Policy for Community Health Plan of Washington.  Ms. Gil is the Senior Public Policy Analyst for Community Health Plan of Washington.