November 12, 2013 Updated: November 13, 2013 at 6:24 am
A stack of papers sits of Jeff Miller's desk - the files of clients held in health care limbo.
These people were supposed to sail through the federal subsidies application process, offsetting the cost of mandated health insurance.
Instead, it often takes weeks.
The clog in this system - a mandatory step requiring shoppers seeking tax credits to be first turned down for Medicaid - worries health care officials across the state as Connect for Health Colorado wades through its second month in business.
Colorado Medicaid officials recently announced some changes - for instance, allowing people to bypass a portion of the Medicaid application if they aren't disabled, or if they need long-term care - but they admit the process still needs streamlining.
To Miller, a health insurance broker with about 20 clients considering plans in the marketplace, it's become a speed bump that complicates gaining access to coverage.
"People expect things to go very easy, streamlined," Miller said. "Insurance is one of those processes... people find it just to be very monotonous, a very frustrating product in the first place, let alone if you add additional steps for them, it drags them out even further."
The concerns arise from a few key components of the Affordable Care Act, or Obamacare.
The law expanded Medicaid to include almost everyone making about 133 percent of the federal poverty level. In 2014, that benchmark is effectively 138 percent because of financing rules.
Almost everyone else making up to 400 percent of the federal poverty level - roughly $45,500 a year for individuals, or $94,000 for a family of four - are eligible to receive some kind of federal assistance.
That's where it starts to get complicated, brokers say.
In order to receive the advanced premium tax credit - a monthly discount for health insurance premiums - shoppers must first be denied Medicaid eligibility.
A confirmation number accompanying each denial is then used to apply for the tax credits through the marketplace, Connect for Health Colorado.
Brokers have complained that the Medicaid form is too lengthy, especially for people who already know they don't qualify for the program. For example, it asks how much money applicants have in their savings accounts, 401K retirement accounts, and if they have any vehicles.
"If I've got an individual earning $35,000 and it's a household of one, they're not even close," Miller said. "Yet they have to go through the same process a someone who's earning $12,000."
Responses also haven't always been instantaneous, further delaying the process, brokers said.
Denials return instantaneously about 60 percent of the time, a number that Medicaid officials are working to raise, said Marc Williams, a Department of Health Care Policy and Financing spokesman.
On average, Medicaid officials have taken 16 days to processes those applications, according to a presentation at the marketplace's Monday board meeting. Federal guidelines mandate a response within 45 days.
In October, about 27,000 people applied for Medicaid and were denied, Williams said. A "great majority" of those were likely applying as part of the process for health insurance, he said.
There's been a little progress: A glitch that prevented would-be subscribers from applying for the federal subsidies online has been fixed.
The fact that the processes needed streamlining after Oct. 1, when the marketplace opened, "has kept some people from being able to sign up," said Mike Fallon, a North Colorado Medical Center emergency room doctor who sits on the exchange's board of directors.
In October, 52,542 people created accounts on Connect for Health Colorado, while 3,408 people became covered under plans purchased through the marketplace.
Given that health insurance is a risk-based business - meaning that affordability is often determined by the number of healthy people who buy in - those numbers need to rise, Fallon said.
"I never anticipated that a lot of people would sign up in October," Fallon said. "If we're still sitting at low numbers the first week in December, we really have to look at the process... and see if we can improve it, because we need numbers."