LegalAidOK.orgOklahoma

LASO Navigators have COVID 19 Healthcare Options

Authored By: Legal Aid Services of Oklahoma, Inc. LSC Funded

Information

Healthcare Options for Clients and LASO Navigator Program                                  

During the COVID-19 season, many clients may be losing health insurance, or seeking healthcare.

Assistance is available in 13 LASO offices from staff trained as Health Navigators (under a CMS grant to LASO).  The LASO Navigators can assist with Marketplace (Healthcare.gov) plan application/enrollment and SoonerCare (Medicaid) information. Here’s how LASO Navigators may help:

For clients losing their health insurance

For people losing both a job and their health plan, the Marketplace enrollment period ends 60 days from date of loss of coverage (not date of job loss). Someone might have lost a job on March 20, but coverage ended March 31...so, enrollment window is open for 60 days from the March 31 loss of coverage (not earlier job loss date)

If consumer applies to Marketplace (Healthcare.gov) before the loss of coverage date, they can select a plan with a start date with no gap in coverage. For example, if a plan is selected before their April 30 coverage end date, then new Marketplace plans starts May 1 (no gap in coverage).

Discounts on Marketplace plans are based on estimate of full-year household income. This means that income already received during the year is counted, plus unemployment and an estimate of future earnings. This is helpful to get clients into the income range for the Marketplace discounts (income above poverty level in Oklahoma).

For the Oklahoma Marketplace, clients have a choice of up to 22 plans from 3 insurers: BlueCross, Bright Health and Medicare.

For Clients with reduced income

Household income may have dropped to levels that make children (under age 19) eligible for free SoonerCare. Examples:  Single parent with one child, income under $3,018/month may have child eligible for SoonerCare. Family of four with income under $4,587/month may have children eligible for SoonerCare. 

Healthcare Navigators at LASO can assist clients with their SoonerCare eligibility options.

COBRA options compared with Marketplace plans

Navigators at LASO can assist clients with gathering information, but Navigators can not provide advice or recommendations. Navigators can help clients complete a Marketplace application to find their personal plan and price options so clients have full information to make their own comparison of COBRA versus Marketplace.

For clients without health insurance

Navigators have information for clients about the Community Health Centers (CHC), which have 90 offices throughout Oklahoma (in most of the same towns as LASO).  CHCs provide primary care medical services with sliding-scale fees, based on current income.  Clients call to make appointments, although some have walk-in service. Dental, pharmacy and behavioral health services are available at some offices.

All CHCs welcome SoonerCare members. The LASO Navigators can assist clients with eligibility information for SoonerCare.

Does the Marketplace have “open enrollment” because of COVID-19?

Not for Oklahoma, or other states in the Federally-facilitated exchanges (FFE). Some states which run their own Marketplace Exchange, such as Colorado, have opened a general enrollment period for COVID-19.

But, whenever someone loses coverage that they had (a plan from work, or losing SoonerCare or Medicare),  Oklahoma Marketplace enrollment generally opens for a 60-day period. Navigators at LASO are available to help clients.

Do Marketplace plans cover COVID-19?

Generally, yes --- both testing and treatment are covered. Many insurers are offering Telehealth visits at no co-pay, including BCBS-OK.

For example, BCBS-OK “won’t require prior authorization and won’t apply member co-pays or deductibles for testing to diagnose COVID-19 when medically necessary and consistent with CDC guidance. This applies to all members we insure. With regard to treatment for COVID-19, Blue Cross and Blue Shield of Oklahoma plans cover medically necessary health benefits, including physician services, hospitalization and emergency services consistent with the terms of your benefits.” Background from CMS:
https://www.cms.gov/files/document/03052020-individual-small-market-covid-19-fact-sheet.pdf

Medicaid Expansion to Adults scheduled to start July 1, 2020

Medicaid Expansion means that many low-income adults may be newly eligible for free SoonerCare coverage at incomes of $0 up to 133%FPL. (Children under 19 continue to have eligibility to higher household income level of 210%FPL.)

Adult SoonerCare eligibility levels starting July 1, 2020 (proposed)

            Household size:          1          Income:  $0--$1,414/month   ($16,971/year)

                                                2                           $0--$1,911/month   ($22,929/year)

                                                3                           $0--$2,407/month   ($29,974/year)

                                                4                           $0--$2,904/month    ($34,846/year)

Medicaid Expansion is due to start July 1, 2020, according to Oklahoma Health Care Authority. This state Medicaid agency reports it has submitted the request to CMS for Federal approval. The premium payments, co-pays and Community Engagement/Work Requirements do not start until a year later, July 1, 2021.  See: http://okhca.org/soonercare2/

COVID-19 info related to Health and Legal Issues

These two organizations cover somewhat different areas of health-related law, so may offer varying resources:

National Health Law Center—emphasis on litigation and government agencies

https://healthlaw.org/coronavirus-resources/

National Center for Medical-Legal Partnerships---emphasis on MLPs and client services

https://medical-legalpartnership.org/mlp-resources/covid-19/

Last Review and Update: Apr 02, 2020
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