Delaying healthcare enrollment could hurt your kids

Sign-ups have mostly run smoothly in the current open-enrollment session, but some of Nevada’s most vulnerable citizens still face issues getting covered.

Some insurance experts say parents are experiencing delays of as long as 60 days enrolling their kids in Nevada Check Up, a publicly funded, low-cost insurance program for children of low-income households.

The enrollment lag is a problem for two big reasons. Start with the coverage effective date. Insurance through other public programs, such as Medicaid, takes effect on the enrollee’s application date. So someone who applies Jan. 1 and waits until March 1 to be determined eligible still will get retroactive coverage to Jan. 1. That means any bills she incurs between Jan. 1 and March 1 will be covered, even though she wasn’t officially enrolled.

That’s not the case with Nevada Check Up, which doesn’t take effect until a member is found eligible.

This is where the second problem comes in: Anyone who’s uncovered for at least three straight months in a calendar year could be hit with a federal tax for going without coverage.

So we asked for an application update from the state Health and Human Services Department, which runs Nevada Check Up. Spokeswoman Miki Allard said the department’s Welfare and Supportive Services Division has 45 days from the date of submission to process medical applications. As of Dec. 31, the agency was processing medical applications in an average of 28 days and processing 90.13 percent of applications within the 45 days required.

“This means that while we do have some outliers, we are working very hard and meeting our processing timeline goals,” Allard said.

Allard said “pending inventory” in Medicaid applications ran at a typical rate of 17,000 at any given time before the Affordable Care Act’s individual mandate took effect in January 2014. Improved processes winnowed that number to fewer than 10,000 in late summer and early fall. But with a narrow open-enrollment window from November to February — a provision of the law that insurance professionals say is creating bottlenecks in private and public enrollments alike — the agency had a pending inventory of 25,000 applications as of mid-January.

So what should parents of Nevada Check Up-eligible kids do?

They can buy a private plan off of the exchange to ensure coverage in an emergency, then cancel when Nevada Check Up kicks in. There’s no penalty for dropping private coverage unless it’s not replaced with another plan.

Plans for kids are available for as little as $99 a month off of the exchange. For kids with health problems, benefit-rich coverage could cost around $200.

■ Virginia wants to know if she’s eligible to buy through the Nevada Health Link exchange even though she has access to a plan through her husband’s job. Her husband’s coverage is free to him, but to sign her up would cost $520 per month. That’s unaffordable to the couple, Virginia said. She’s unemployed, so the household has no other source of income.

We crunched some numbers, and yes, Virginia, you should be eligible to buy a subsidized plan through Nevada Health Link.

Based on the numbers you gave us, your health insurance premium would represent 16.3 percent of your household’s income. Under the Affordable Care Act, you can buy on the exchange if coverage through a workplace plan equals 9.5 percent or more of your income. That’s the threshold for what the law considers “affordable.”

It’s important to note that anyone can buy an individual plan through the exchange. It’s just that you won’t get the tax credit or cost-sharing deductible reductions if your employer-sponsored plan premium is less than 9.5 percent of household income.

Nevadans have until Feb. 15 to enroll in a plan.