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Affordable Care Act help unit just half staffed

CHARLESTON, W.Va. -- A month into the Affordable Care Act's open-enrollment period, a majority of the in-person "assisters" to help people get health insurance in West Virginia are not yet hired.

The state Office of the Insurance Commissioner originally planned to hire 270 people to help West Virginia residents enroll in the state's health insurance marketplace and its expanded Medicaid program, according to grant applications state officials made to the Center for Medicare and Medicaid Services. The Gazette obtained the records through an open records request.

The state now plans to hire 170 in-person assisters, or IPAs, insurance commissioner spokesman Jason Butcher said.

IPAs are trained, full-time workers paid $20 an hour to help state residents enroll in health insurance, according to Perry Bryant, executive director of West Virginians for Affordable Care.

Only about 80 of them have been hired and are working, Bryant said.

Open enrollment in the state's expanded Medicaid program and the Health Insurance Marketplace began Oct. 1 and will continue through March 31.

"We're going to lose one-sixth of the enrollment period with them not being in place," Bryant said.

He said the IPA program was meant to be a key part of the state's outreach to uninsured people -- especially because Gov. Earl Ray Tomblin turned down millions of federal dollars to have a state-run media campaign about the Affordable Care Act.

"I think it's a big deal," Bryant said. "They were [to be] the backbone of the outreach efforts."

Butcher said four companies have been chosen to provide more IPAs. Contracts with those companies are "in the purchasing stages," he said.

He acknowledged that original estimates were that West Virginia would need 270 assisters to help people enroll in health insurance. But the federal government added more resources and helpers under different names, so the state did not need to hire as many IPAs as originally thought, he said.

In addition to in-person assisters, there are navigators, certified application counselors and insurance agents who are helping enroll people in health insurance, Butcher said.

He believes there are more than 200 workers around the state who can help people enroll in health insurance.

But Bryant said the original plan was to hire 270 IPAs in addition to the other helpers.

"That is what they consistently told everyone," Bryant said.

The state is putting an in-person assister in every county DHHR office and will have IPAs in the state's Bureau of Senior Services offices, Butcher said in an email to the Gazette.

Most of those are in place already, officials have said.

"The IPA program overseen by the state will provide approximately 170 individuals, which when added to the navigators, CACS, and [insurance] agents also providing these services should provide our citizens with trained resources close to where they live should they have questions about the ACA and how it impacts them," Butcher said.

The state got about $14 million in federal funding for customer assistance, including around $4.5 million that went to Reston, Va.-based agency Maximus for training and oversight of IPA workers.

Butcher said the OIC does not intend to send any of the money back to the federal government.

"No funding has been returned, nor is there any anticipation to return the funding," Butcher said in an email to the Gazette. "Our grant funding is available through the end of 2014, so we plan to utilize any remaining funding to assist with enrollment during next year's open enrollment period."

The 270 was not a concrete number of IPAs needed, but rather "a projection of needed resources based on an anticipated amount of time needed to enroll in the Marketplace," Butcher said.

"If you would take the new White House projection of only needing 0.48 hours to enroll, we'd only need 65 assisters [of any kind]; we've already exceeded that amount with just IPAs alone," Butcher said in an email.

But while the state is still working to put its IPA program in place, that hasn't stopped the Department of Health and Human Resources from signing people up for health insurance.

So far, about 60,000 people in West Virginia have signed up for expanded Medicaid. About 52,000 have responded to letters and phone calls from the DHHR to SNAP recipients and parents of children enrolled in Medicaid, Jeremiah Samples, assistant to DHHR secretary Karen Bowling, told the Gazette.

Another 2,600 people have enrolled in Medicaid at county DHHR offices and 5,000 have applied through the state's Medicaid enrollment site, wvinroads.org. That number does not include anyone who may have been able to enroll via the federal government's website, healthcare.gov, Samples said.

State officials anticipated about 65,000 residents to sign up for Medicaid in fiscal year 2014, he said. About 135,000 West Virginians are newly eligible for Medicaid since Tomblin agreed to expand the program to those who make up to 138 percent of the federal poverty line, Samples said.

Officials believe West Virginia has the highest number of people, per capita, enrolled in Medicaid in the nation, Samples said.

If state projections are correct and about 250,000 West Virginians are uninsured, about a quarter of them already have enrolled and should have Medicaid coverage beginning Jan. 1, Bryant said.

"That's just remarkable," Bryant said. "Imagine if the OIC and the [U.S. Department of Health and Human Services] were doing the same quality job as DHHR. Imagine how many people we could have enrolled."

Reach Lori Kersey at lori.kersey@wvgazette.com or 304-348-1240.


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