Healthcare navigators still at work

By DeeAnna Haney | May 26, 2014
Jan Plummer is the coordinator for the healthcare navigators.

Though open enrollment for the federal healthcare marketplace closed at the end of March, local healthcare navigators are still hard at work helping people in Western North Carolina sign up for health insurance.

Mountain Projects, Inc. was one of four agencies in the state to receive a federal grant last August to fund healthcare navigators, whose job has been to help people understand and sign up for insurance on the new marketplace through free in-person interaction.

Five people were hired to get certified and serve the seven westernmost counties — Haywood, Jackson, Macon, Swain, Clay, Cherokee and Graham. Then, the navigators were spread out to meet the needs of the widespread rural areas, said Jan Plummer, healthcare navigator coordinator.

"We purposefully wanted to have people that were local to the counties so it would be really convenient for citizens to reach them," Plummer said.

The first several months were very busy for the healthcare navigators. They began their jobs with outreach programs to get people interested and educated.

By October, they were starting to enroll people. But glitches in the online enrollment system were causing delays across the nation.

"In the first month we were only able to utilize the paper application process," she said.

She estimates about 100 paper applications were filed until the online enrollment started functioning correctly in November.

"Because we had been doing the paper application, we felt like we had a head start and new what to expect in the electronic application process," Plummer said.

As word spread, the navigators got even busier.

"Once one person was enrolled successfully, they started calling their friends," Plummer said.

And as the initial deadline of March 31 approached, the navigators were working in overdrive.

"Most of us didn't have any appointments available on our book and we were working Saturdays and evenings and doing the best that we could to meet the demand because we really wanted everybody that was interested in the insurance to have the chance to enroll," Plummer said.

With the largest population, Haywood County was the busiest followed by Jackson County.

Several local agencies including Haywood County Department of Social Services, Haywood County Health Department, The Good Samaritan Clinic, Haywood County Senior Resource Center, Mountain Area Recovery Center, Haywood County Public Libraries, Haywood Community College, The Open Door and the Haywood County Sheriff's Office provided space for navigators to work with the public.

"It just made sense to be at DSS because the people that weren't eligible for Medicaid could come to a navigator to assist them with the application process to see if they were eligible for one of the affordable care programs," Plummer said.

Because of all the local businesses and organizations who were willing to work with the navigators, Plummer said she believes the program has been a success.

Because nationwide technical issues with the online application held so many back from successfully enrolling, the deadline was extended to April 15 to accommodate those on a waiting list.

"I think the last person I helped was probably at 11:30 p.m. on April 15," she said.

In the end, she said healthcare navigators personally assisted about 1,300 people between the seven counties.

An open marketplace

Now, healthcare navigators have shifted their attention to the special enrollment period, which is ongoing. Getting married or divorced, losing work-provided health insurance, having a baby, moving from out-of-state or gaining citizenship status are just some of the examples of “qualifying events” that mean a person can enroll without facing a fine.

For example, last week Plummer traveled to Robbinsville to help employees at the Stanley Furniture plant sign up for insurance as the plant prepares to close down, an event that is causing 400 people to lose their jobs.

There's also a special enrollment for the recently incarcerated.

"Once they are released, they have a 60-day special enrollment period and for their family as well," Plummer said.

Those who have been a victim of domestic violence who don’t have health insurance have until May 30 to enroll in insurance.

"If they are married but not living together, there is a special provision so you don't have to indicate your spouse’s name so you don't have to file jointly," Plummer said.

For those who qualify for special enrollment, it's a good idea to have a navigator help with the process, which can be complicated, she added.

Special exemptions

According to the law, people who qualified for insurance through the marketplace but failed to enroll in some type of insurance plan will face a penalty of $95 or 1 percent of the household income. However, there are many instances that qualify people for exemptions from that penalty.

Just a few of the exemptions include homelessness, eviction from the home in the past six months, receiving a shutoff notice from a utility company, death of a close family member, or being a victim of a disaster that caused substantial damage to property.

Another exemption that affects many is if a person is determined ineligible for Medicaid because the state didn't expand Medicaid eligibility, which applies to North Carolina.

"Anybody below 138 percent of that poverty level would be exempt. We have people that fall below that who have enrolled in a plan and have gotten rates as low as $2.17 a month with a $500 deductible, as an example," Plummer said.

Few people are coming to the navigators about an exemption, mostly because they don't know it exists. That's why healthcare navigators are trying to get the word out that they can help.

"We need to make people aware that we want to help people who have been in these type of situations not have to worry about being penalized," Plummer said.

Filing for an exemption involves filling out paperwork and mailing it in and, in turn, the consumer receives an exemption certificate number, which must be included when the individual files their taxes.

The application can easily become confusing, but the healthcare navigators can help sort through the process.

"It's a pretty challenging application sometimes, especially in the income section it can be confusing. The challenge we have here is that a lot of people don't have computers or they don't want to get on a computer,” Plummer said.

That’s why she believes the navigators will still have work to do even after the grant funding the program expires in August.

“I think we definitely need to be around for another season,” she said.

There will be an opportunity for Mountain Projects to file for an extension on the grant and possibly seek other grants. But until then, navigators are reaching out to help whoever still needs it.

"There are options. Not everyone will be penalized if they didn't take this insurance," Plummer said.

Of all the people they worked with, about 30 percent of them were not eligible for the tax subsidy in the Marketplace. Of that 30 percent, Plummer estimates about 80 percent of them weren’t eligible for Medicaid, either.

"So we definitely have a coverage gap. It's really hard to tell someone that you're making too much money to qualify for Medicaid, but you're too poor to qualify for the subsidy," Plummer said.

That's why she said there is still a need for places like the Good Samaritan Clinic to provide free or sliding scale based healthcare.

"Thank goodness they are there because there are still a lot of people that fall into that coverage gap," she said.

For a full list of what qualifies as special enrollment or an exemption, get in touch with a local certified healthcare navigator for a free in-person appointment by calling 1-800-627-1548.