Missouri health care guides respond to low enrollment figures

Thursday, November 14, 2013 | 6:17 p.m. CST; updated 9:56 p.m. CST, Thursday, November 14, 2013

COLUMBIA — Before Carlotta Lewis turned 18, she had a $3 copay at the dentist. Under her state-funded Medicaid insurance, she could go to the doctor for back pain. She could break her leg and get a cast put on. It was all covered.

But that’s not the case anymore.

How to contact a navigator

Columbia residents interested in learning more about open enrollment can:

  • Contact a Primaris navigator at 573-817-8338 or via email at The service is free, and every navigator and certified counselor goes through a criminal background check in the Primaris coalition, Milarsky said.
  • Attend the enrollment session from 9:30 a.m. to 3:30 p.m. Saturday at the Columbia Public Library.
  • Call the Central Missouri Area Agency on Aging at 573-443-5823 to find out about the next scheduled health care marketplace information session.

Lewis, 20, is a MU student and independent from any legal guardians. She hasn’t had health insurance in two years and doesn’t know when she’ll get it. It’s simply not a priority.

"Until I break something or pull something in my knee, maybe running or something, it won’t be important for me to have insurance," Lewis said.

Instead, she’s paying for her tuition, her car insurance and her cellphone bill. She works two jobs — a campus work-study and a part-time gig at a local movie theater — in addition to going to school.

"If I was a parent, I would probably be trying to get it," she said. "Insurance for me and my children would be first. But I’m just in school right now — it's not a top priority."

Lewis said she has gotten letters and pamphlets from MU about the Affordable Care Act, but she doesn’t understand what everything means.

Since the health care marketplace opened Oct. 1, few Missouri residents have successfully enrolled in new health care plans. Of the 14,000 residents who submitted applications for health coverage, figures released Wednesday show that only 751 Missouri residents have chosen insurance plans.

According to several mid-Missouri insurance navigator groups, a lack of understanding about health care benefits and technological glitches have hindered the registration process.

Jeremy Milarsky, navigator program manager for Primaris Healthcare Business Solutions, said that, as of Nov. 8, Primaris navigators had worked with 466 people and helped 35 create profiles on Eight of the 35 have gotten all the way through the process, and an additional six decided to start with the paper application, Milarsky said.

But he cautioned against drawing too many conclusions from the number of people working with navigators because many people register for insurance without assistance.

"I don't know that we're the perfect canary in the coal mine," Milarsky said.

People might not understand how to register by themselves.

"We’re trying to do educational events in each town," said Jean Leonatti, CEO of the Central Missouri Area Agency on Aging. "People don’t seem to understand how the system works."

The Central Missouri Area Agency on Aging is a private, nonprofit corporation that helps community members establish health insurance services. Since open enrollment began, delegates from the agency have been hosting events in 19 different counties to educate the public about the registration process.

Although attendance at most of these events barely inches out of the teens — a total of 20 people showed up at the session in Jefferson City — Leonatti said confusion about registration and technology problems have slowed the pace of enrollment.

"The website is pretty troublesome at this point," she said Thursday. "I have gotten one person totally enrolled. We have people who get halfway through the process, and then there are glitches."

The slow pace has forced the agency on aging to ask people to return multiple times, Leonatti said. She has had one woman come back three times to finish enrollment.

"People are ready — they’re ready to sign up," Leonatti said. "They’re excited about the insurance."

Milarsky attributed some of the low enrollment numbers to people taking their time to decide on a plan. He expected more people to sign up as the deadline approaches.

"A lot of folks don't have to choose now, so they're not. They're sitting down with their budgets to find out if it's right for them," Milarsky said.

Nearly four in 10 uninsured Missourians are eligible for a no-cost bronze plan, according to an analysis by consulting firm McKinsey and Co. that was described in a Nov. 3 article in The New York Times.

Navigators at Primaris have encountered quite a few Missourians who fall within the Medicaid coverage gap, Milarsky said. About 200,000 Missourians make too much money to qualify for Medicaid but not enough to trigger government subsidies. When assisting individuals whose incomes fall within the gap, Milarsky suggested opting for a catastrophic plan or finding a way to push their incomes above the poverty line.

According to previous Missourian reporting, Primaris Healthcare Business Solutions and the Area Agencies on Aging received $1.7 million to hire navigators.

As of Friday, there were 84 active navigators at Primaris, 64 of whom had completed training and 56 of whom were licensed. The navigators are funded by two grants: one from the federal government and another from the St. Louis-based Missouri Foundation for Health. There are four federally funded navigators in Columbia and three active and trainee navigators funded by the Missouri Foundation for Health, Milarsky said.

Help from a Primaris navigator or an information session hosted by the Central Missouri Area Agency on Aging might be enough to get Lewis to enroll. She said she would be willing to consider it if she had more information.

"It's about time for me to get my checkups," she said.

Supervising editor is John Schneller.

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