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Displaced Puerto Ricans face obstacles getting health care

Paula Andalo, Kaiser Health News on

Published in Health & Fitness

The federal government has granted people affected by the devastating hurricanes that wracked coastal states and Puerto Rico 15 extra days to sign up for health coverage under the Affordable Care Act.

But Puerto Ricans who fled to the mainland after the destruction face problems well beyond timing.

Many of those Americans have complicated questions about whether the Medicaid or Medicare coverage they had in Puerto Rico will shift with them to their new locations. And for those seeking private coverage, using the ACA's insurance marketplaces will likely be a new experience because the federal health law didn't establish those marketplaces in the U.S. territory.

Members of Congress from Florida said last Wednesday they are concerned that many of these recent arrivals, as well as insurance companies and navigators, are confused. They sent a letter to Seema Verma, the director of the Centers for Medicare & Medicaid Services (CMS), requesting that federal officials put out a fact sheet to "provide much-needed clarity and alleviate confusion" among Puerto Ricans who have relocated to the States.

Insurance enrollment on the health law's marketplaces ends for most people Dec. 15. In a bow to the hardships caused by the August and September storms, residents living in hard-hit areas of Texas, Florida and Georgia are allowed to sign up as late as Dec. 31. But waiting until those final 15 days means that the start of their coverage is delayed until Feb. 1.

Many Puerto Ricans driven from their homes, however, are negotiating layers of red tape. In Puerto Rico, nearly three-quarters of Medicare beneficiaries are in private Advantage plans. Many have questions about whether those plans will cover them stateside.

 

Also, the Medicaid program for low-income residents in Puerto Rico covers nearly half of the island's residents -- a rate higher than any state -- but it's not clear that people moving stateside will continue to qualify because they may not meet the tighter eligibility standards. That is especially true if their new home state did not expand Medicaid under the ACA to all adults earning up to 138 percent of the federal poverty level (about $16,000 for an individual).

At the very least, they will have to reapply for Medicaid coverage. Often the most effective route is through the ACA marketplaces. That process will show them whether they are eligible for Medicaid or perhaps a federal subsidy to purchase a private plan.

According to a CMS memo released in September, they can call the HealthCare.gov help line (1-800-318-2596) for help. The memo, which doesn't provide details about what documentation is needed, also says that "individuals may experience qualifying events due to a hurricane that makes them eligible for a special enrollment period (SEP)" to access another health plan. For example, individuals who temporarily relocated to Florida due to a hurricane and are now out of their health plan coverage area could be eligible for a special enrollment period because of the move.

After the storms hit, the Federal Emergency Management Agency (FEMA) designated all counties in Florida and Georgia, and 53 in Texas, to receive "individual assistance" or "public assistance." In Puerto Rico, this category was granted to 31 of the island's 78 municipalities.

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