SAMHSA SOAR

Assisting with Medicaid and Marketplace Enrollment

Helping individuals enroll in Medicaid or coverage through the Health Insurance Marketplace has never been easier. By assisting with the application, consumers are able to gain access to timely preventative care and providers are able to recoup costs from previously uncompensated care.

Medicaid and Marketplace Enrollment

Benefits for Consumers: Access to Care

Focusing on health insurance and health care enrollment will lead to consumers accessing preventative health care, can help avoid emergency room usage, helps the consumer build relationships with physicians, supports people to stay healthy and improves the overall health of the community.  

Benefits for Providers: Medicaid Reimbursement

Providers can recoup the cost of uncompensated care from Medicaid for up to 90 days retroactive to the date of SSI eligibility. Some SOAR providers have been tracking these reimbursements and in 2023 saw reimbursement of $5,570 on average for each approval.
 
Medicaid dollars coming into local communities and community programs make a difference in budgets and local economies.

When to Enroll?

In expansion states, consumers should enroll in health coverage as soon as possible.  Quick access to Medicaid will mean access to treatment, evaluations and additional evidence that can be helpful in supporting disability applications. 
  • Once the consumer is approved for SSI, they can change their Medicaid coverage based on their eligibility for SSI
  • They should be sure to indicate that they are disabled on their original Medicaid application

Annual Open Enrollment Period

Enrollments in or changes to a Health Insurance Marketplace plan can only take place during the annual Open Enrollment Period (OEP), or during a Special Enrollment Period (SEP) if the individual meets qualifying circumstances. The OEP for 2024 coverage is November 1, 2023 - January 15, 2024.
  • Members of a federally recognized Indian tribe or Alaska Native shareholders can sign up for or change plans once per month throughout the year
  • Find out more at: HealthCare.gov
NOTE: Individuals eligible for Medicaid are able to enroll at any time. The OEP only applies to those who are purchasing coverage in the Health Insurance Marketplace.

Special Enrollment Period

Under certain circumstances or based on qualifying life events, a person may be able to enroll in the Marketplace or change plans outside of the OEP, using the Special Enrollment Period (SEP). Examples of qualifying events include, but are not limited to: losing current medical coverage, marriage or divorce, birth or adoption, obtaining citizenship, or gaining access to new Qualified Health Plans as a result of a permanent move.
  • Most SEPs last 60 days from the date of the qualifying life change
  • Individuals should contact the Marketplace call center at 1-800-318-2596 (TTY: 1-855-889-4325) if they believe they are eligible for the SEP.

Applying for Medicaid and Marketplace Coverage

Individuals can apply for coverage for both Medicaid and in the Marketplace by phone, online, in person, or by mail.
  • The National Health Insurance Marketplace call center: 1-800-318-2596 (TTY: 1-855-889-4325). Assistance is available in 150 languages.
    • Staff at the call center help individuals go through the eligibility and enrollment process, and connect them with local in-person help
  • Apply online at: Healthcare.gov. The website is also available in Spanish at Cuidado.DeSalud.gov.
  • In-person help is available and you can find trained and certified Navigators by visiting Localhelp.Healthcare.gov, or by calling the Marketplace call center
  • The paper application is available for download and printing (PDF).

Do individuals have to gather lengthy documentation to apply?

No! The application process has been streamlined and does not require people to gather past medical records or lengthy documents, which we know can be a barrier for individuals experiencing homelessness.
  • The application process primarily relies on electronic sources, so there is a reduced need for paper documentation
  • A single, electronic source known as “The Hub” helps process verifications for multiple sources including Homeland Security, the IRS, and SSA
  • Testimony from the applicant can be used for most factors of eligibility (excluding citizenship status and immigration)

How often does someone need to renew the insurance?

Renewal is required no more than every 12 months and forms come pre-populated to beneficiaries, reducing the time required to complete the process.

Outreach for Medicaid and Marketplace Enrollment

SOAR providers are perfectly positioned to talk with individuals experiencing or at-risk for homelessness about increasing their access to health insurance. Some tips for the outreach process:
  • Use plain language without technical jargon
    • Focus more on how health insurance can benefit the individual that you are working with and meet his/her needs
  • Incorporate information about health insurance options into your outreach efforts for SSI/SSDI
  • Recognize that some individuals may have been denied for health insurance in the past and may be hesitant to go through the process again
    • Help assure them that the process has changed and that applying has never been easier
Watch as Will conducts outreach in the park and speaks with Bones about enrolling in Medicaid:
 

In this scenario, Will is working with Bones on a SOAR application and talks with him about enrolling in Medicaid:

 

Details

Type:
Adult Course
Date:
October, 2017

Other Details

Topic
Health Care

Explore Related Resources