The Department of Human Services withdrew its request for an appropriation of $4 million for 100 outreach workers, known as "guides," to identify people newly eligible for health insurance under the Affordable Care Act and help them sign up. These guides would have been stationed in DHS county offices throughout the state, with a particular focus on signing up people eligible for fully subsidized private insurance under the "private option" for Medicaid expansion. These 100 guides were added on because of the expansion, on top of 542 guides that are fully federally funded as part of the ACA.
DHS decided to pull back the request after objections from lawmakers over funding. DHS officials testified earlier this month to the Performance Evaluation and Expenditure Review (PEER) joint subcommittee that they had received word from the Center for Medicare and Medicaid (CMS) that the state would need to contribute 50 percent (or $2 million), with the feds contributing a 50 percent match. It was originally thought that these additional 100 "private option" guides would be fully federally funded like the other 542 guides.
DHS testified to PEER that the contribution on the 100 guides would not require any additional state expenditure on net because of an unrelated piece of news from CMS: administrative activities related to enrollment and eligibility for the expansion population will get a 75-25 federal match instead of 50-50 as expected, so DHS planned to use savings from that change to pay for the needed match on the guides.
In the end, however, DHS spokesperson Amy Webb said they decided against trying to use any state general revenue funds for the 100 guides. "We're looking for other resources within the department to fund those," Webb said. "We still need the guides, we just need to figure out a different way to fund them."
Webb said they were "working aggressively to find solutions" and looking for "alternative resources" through existing DHS funding, but it was unclear at this point whether DHS would be able to hire the guides or not. If they do end up finding a way to hire them, they would get a 50 percent match from the feds.
Webb said that one alternative DHS was examining is "IT solutions to reach out to this population. For example, say we've got families in SNAP. We have their verified income, all their documentation verified in our system. We can go in there and identify families that would be eligible and contact them."
The guides program will still proceed with the 542 fully federally funded outreach workers, who will begin training this summer. These guides will work both with the "private option" population (people below 138 percent of the federal poverty level), as well as folks eligible for subsidies on the exchange (people between 138 and 400 FPL). The reason for the extra 100 is that policymakers anticipate that many people newly eligible via Medicaid expansion will come to DHS to sign up (and also that DHS may be interacting with new eligibles for other reasons, with an opportunity for outreach on health coverage).
"We know that people are going to come in to the county offices," Webb said. "A lot of folks, especially in the more rural counties, that's their go-to place when they have a need so we know they'll go there."
This is a good place to note again the importance of outreach and the guides program. This is important not just for bleeding-hearts reasons (though that's important!) but for the policy success of the "private option." Keep in mind that most people in the expansion population will be too low-income to face the individual mandate. If healthy people eligible for no-premium insurance don't sign up — because they don't know they're eligible, or don't know where to go, or are confused by the process, or just don't bother — that could lead to "adverse selection," which would mean higher premiums and higher costs to taxpayers, who are subsidizing those premiums.