MIke Maples, CEOMike Maples, MD

A New Year….a New Era

Without much fanfare, we are now beginning to see the most anticipated outcomes from the Affordable Care Act (ACA, aka Obamacare).  Those, of course, are the expansions of insurance coverage through the Exchange (aka: Marketplace) and expanded Medicaid.

Where do we stand, and what should we expect?  Hard to know for sure, but here are few facts and figures to keep in mind:

¨          Washington’s version of the online Marketplace (wahealthplanfinder.org) worked substantially better than the national model.  There were still problems, but despite those, our outreach and enrollment workers had assisted nearly 5,000 and enrolled nearly 1,000 by the deadline (December 23).

¨          The 12/23 deadline was only the deadline for the enrollment to be effective as of January 1, 2014.  Enrollment in Medicaid will be ongoing throughout the year.  For plans purchased on the Exchange to be effective this year, open enrollment will continue until March 31.

¨          In addition to insuring low-income adults (up to 138% of the federal poverty level), Washington Medicaid will also provide oral health benefits for adults, but current and newly eligible.  Prior to Jan. 1, children on Medicaid had coverage for dental needs, but adults were covered only for emergencies.  Now they will have benefits for preventive and some restorative services, as well.

¨          Statewide, over 150,000 new Medicaid enrollees signed up.  An equal number of re-enrollments were certified.  In Yakima County, for the 1/1/14 effective date, over 5,000 people are newly covered.  In Kittitas County, that number is 779.

¨          In the Exchange, statewide, as of Dec. 24, 65,000 people had signed up and paid for coverage.  Another 70,000 had done everything BUT pay the premium.  The plans may give them some extra time to do that.

¨          The State has re-branded the Medicaid programs and “Apple Health”, and the Basic Health Plan no longer exists.  We are still contracted primarily with Coordinated Care and Molina for Medicaid, but we have joined the Community Health Network of Washington and will be contracted with CHPW soon.

¨          On the Exchange product side, we will be contracted with every plan offered in the Exchange.


Our challenges will be to keep up with the demand for services, and to maintain our panels at a manageable size.


As always, I’m happy to discuss any questions or concerns that you may have.


Mike Maples, MD