Although only a few hundred middle-class Illinois residents were able to sign up for health insurance last month on the crippled federal HealthCare.gov website, the poor appear to be having an easier time enrolling in an expansion of Medicaid -- and are doing so by the thousands.
Illinois is among states expanding Medicaid under President Barack Obama's health care law. It's the state, not the federal government, that's overseeing efforts to enroll new clients, and state officials have come up with some effective ways to do it -- especially for people already getting food stamps.
In late August, Illinois offered "express enrollment" to people already receiving food stamps. The state sent a letter to 123,000 food stamp recipients, and received 46,000 Medicaid applications in response.
Separately, health advocates say a new Illinois online enrollment site called ABE has been working well. Illinois has received more than 44,000 applications for Medicaid since Oct. 1 when the site launched.
For unemployed construction worker Jerome Davis Jr., signing up through ABE was easy.
"I made an appointment. Bada bing bada boom," Davis said about the ease of completing an application. "Unbelievable."
The expansion of Medicaid means he'll be able to see a doctor without fear of medical bills he can't pay. The 36-year-old Chicago resident knows he has high blood pressure, but has been unable to afford treatment. He completed an application Friday at Westside Health Authority in Chicago after hearing about the opportunity from an outreach worker distributing pamphlets on the street.
Coinciding with the launch of HealthCare.gov, Illinois unveiled its upgraded online application system for Medicaid, called ABE after the 16th president and standing for Application for Benefits Eligibility, and began actively enrolling people through the site. The $160 million upgrade is being financed mostly with enhanced federal matching funds, which have been claimed by most states.
The contrast between Illinois' working technology and the botched rollout of the federal marketplace isn't lost on the state's top Medicaid official, Julie Hamos.
When the health law passed in 2010, the federal government urged states to update their information technology "and really get ready," Hamos said. "I wish they had told that to themselves," she added glumly, "but never mind."
And in a third Medicaid expansion effort, Cook County received federal approval to get an early start on offering Medicaid to adults without dependent children, a year before the rest of the state. That effort has generated 115,000 applications. The state enrolled 52,000 of those applicants and is processing the rest.
Obama's health care law was originally written to expand Medicaid to people making up to 138 percent of the federal poverty line, or nearly $15,860 for an individual.
It's not clear yet how many new Illinois Medicaid recipients there will be in 2014 under the law's expansion of the state-federal health program for the poor. State officials are still verifying the applicants' eligibility and they say there may be some overlap in the reported numbers.
About half the states, including Illinois, are expanding Medicaid under Obama's health law, which in effect became optional for states after a Supreme Court ruling last year.
The federal government is operating Illinois's new insurance marketplace, leaving middle-class residents subject to the website's technical problems. It also means some people who may be eligible for Medicaid are trying to apply through HealthCare.gov.
Hamos said she doesn't know how many Medicaid applications may be on hold in the federal system.
Here's a look at the Illinois efforts:
ILLINOIS WEBSITE WORKING
While health advocates in Illinois are frustrated with the federal website, they report the ABE system, designed by Deloitte, is working well. It allows electronic signatures and electronic submission of documents.
However, it's unclear for now whether the tally of 44,000 applications differs in any significant way from the normal volume of applications, Hamos said.
"It's not that different from recent online application history" of 35,000 to 40,000 applications per month, Hamos said. "I don't know if we're seeing a big uptake at this point. We don't know who these clients are."
She said they eventually will analyze how many applicants are newly eligible for Medicaid and how many were already eligible.
FOOD STAMP EXPRESS
In a separate effort, Illinois offered "express enrollment" to people who already were receiving food stamps. The state sent a letter in late August to 123,000 food stamp recipients. In response, the state received 46,000 Medicaid applications and has so far enrolled 32,000 of the applicants.
Illinois is among five states with federal approval to target food stamp recipients for Medicaid enrollment. The other states, according to the Kaiser Family Foundation, are Arkansas, Oregon, West Virginia and New Jersey.
EARLY START FOR COOK COUNTY
Last year, Illinois sought and received federal approval for Cook County to expand Medicaid early, a year ahead of the national health law's expansion, in order to bring millions of federal dollars into the county's struggling health system.
Cook County so far has submitted 115,000 applications to the state's Medicaid program. The state has enrolled 52,000 of those applicants and is processing the rest of the applications.