Boricuas in the United States face obstacles to having health insurance

AdvertisementAdvertisement By Paula AndaloKaiser Health News | Nov 28, 2017at6:30 PM

The federal government gave people affected by the devastating hurricanes that hit coastal states and Puerto Rico this summer an extra 15 days to enroll for health coverage under the Health Care Act Affordable (ACA).

However, Puerto Ricans who have settled in the continental United States after their homes or businesses were destroyed face more complex problems than that deadline.

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Many of these Americans have difficult questions about whether their Puerto Rico Medicaid or Medicare coverage can change (or even not work) in their new homes. And for those looking for private insurance, using the ACA marketplaces is probably a new experience, since the federal health law was not established on the island.

Members of Congress from Florida said Wednesday, November 15, that they are concerned that many of these newcomers, as well as the insurers and navigators that help consumers with enrollment, are confused. The group sent a letter to Seema Verma, director of the Centers for Medicare and Medicaid Services (CMS), demanding that federal officials send out a fact sheet to "provide necessary clarity and alleviate confusion" among Puerto Ricans who have relocated to the United States.

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For most people, the open enrollment period for coverage through the Health Law Marketplaces ends on December 15. In light of the hardships caused by the August and September storms, residents in the hardest-hit areas of Texas, Florida, and Georgia have an extra 15-day grace period to register, until December 31. But delaying enrollment means the start of your coverage would have to wait until February 1.

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Many Puerto Ricans driven from their homes, however, are facing a more complicated process. In addition to those learning how to use the private insurance marketplaces, some are applying for new Medicare coverage. In Puerto Rico, almost three quarters of Medicare beneficiaries have private Advantage plans. Many have questions about whether they will continue to be covered by those plans on the mainland.

In addition, the Medicaid program for low-income residents of Puerto Rico covers almost half of the island's residents, a higher rate than any other state, so people who move to the continental United States may not qualify. This is especially true if your new 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). Such is the case in Florida.

At a minimum, new residents who want Medicaid coverage will need to reapply. Generally, the most effective way to do this is through the ACA marketplaces. That process will show them if they are eligible for Medicaid or maybe a federal subsidy with which they could buy a private plan.

According to a CMS memo released in September, those displaced by the hurricanes can call the healthcare.gov helpline (1-800-318-2596) and apply. The note, which does not provide details about what documentation is needed, also says: "Individuals may experience qualifying events due to a hurricane that make them eligible for a Special Enrollment Period (SEP)" to access another health plan. For example, people who temporarily moved to Florida due to a hurricane and are now outside their health plan's coverage area may be eligible for a special enrollment period due to the move.

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

Still, Anne Packham, director of the navigator project at Primary Care Access Network, an Orlando-based organization that is part of the Covering Central Florida network, said the focus should be on encouraging consumers to register early on December 15, the last day people can sign up for coverage that begins January 1.

"It's already very confusing, and we think telling consumers they can sign up through December 31 during a special period is adding to the confusion," he said. "These people need insurance right now, on January 1, not February."

After the hurricane, more than 140,000 Puerto Ricans arrived in central Florida, according to Gov. Rick Scott's office, to stay for months, or to settle and start a new life. Searching for insurance and medical care has been arduous.

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Marni Stahlman, president and CEO of Shepherd's Hope Inc., an Orlando-based organization that helps people find coverage and services, he remembered a Puerto Rican couple who had a hard time.

"The man had Medicare, and she, who is a retired teacher, has health insurance through her union. They both ran into obstacles," Stahlman said. "The husband's Medicare plan was not applicable on the mainland and neither was the wife's private plan. They have both had to start over. He reapplied for Medicare and she had to apply for the first time in a market of insurance. Right now they're still without coverage, something they've never had to deal with."

For many families, a lack of documents and supplies complicates the situation. The hurricanes not only devastated lives, homes and power, they also wiped out medicines, prescriptions, health insurance cards and copies of tax returns.

"Help for everyone, but for Puerto Ricans in particular, has to be comprehensive because these people only arrive with their passports," said Jean Zambrano, vice president of medical operations at Shepherd's Hope.

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Among the new arrivals in Florida, there are at least 18,000 children and adolescents who need immediate medical attention, due to that they are required to have vision and hearing exams, and present their immunizations, to attend school. Stahlman and Zambrano said there is no coordinated effort at the state level to pave the way for them.

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The articulation of these processes between the territories and the continental United States is not a smooth mechanism, and medical attention can be overlooked, which means that the last resort for many who need a doctor is the emergency room.

Those who arrive with their important documents have success a little more assured. María Gotay, 51, arrived in Orlando from Bayamón, Puerto Rico, with her two sons, Cristian, 17, and Edwin, 22, 10 days after Hurricane María devastated the island.

"We keep our documents in a safe place," she said, so she had them ready when she applied for health coverage for her children.

Navigator Doris Allen of Primary Care Access Network helped her enroll her youngest son in the Children's Health Insurance Program (CHIP) and her oldest son in a private plan for $33 a month after a subsidy. Maria Gotay was already covered by Medicare: she has a disability status since she suffers from fibromyalgia.

"We were very lucky to meet people who supported us," Gotay said. He remembered arriving at the health center and falling into Allen's arms crying uncontrollably. "I never wanted to leave Puerto Rico, I never imagined being on the brink of death."

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"During the hurricane, we were all together, our house was damaged and flooded, but it withstood Maria's attack," Gotay said.

The woman brought her children to Orlando because her two daughters already live there. Her husband stayed on the island taking care of her father, who shows signs of Alzheimer's.

Gotay said she has been living with stress and fear since the hurricane, and that she has been seeing a psychiatrist in Orlando who is helping her through it. Despite everything, she will return to Puerto Rico this month, while her children will stay in Florida and start a new life.

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This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

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