Updated: Legally Present Marketplace Protocol (Marketplace)


Updated: Legally Present Marketplace Protocol (Marketplace)

Our enrollment assistance team at PrimeCare spends a lot of our time helping immigrants and new residents who are trying to submit a Marketplace application. For every 10 applicants that we see daily, between 4-5 are legally present individuals experiencing difficulties enrolling in health insurance.  The Marketplace describes individuals who are eligible for coverage but who do not have US citizenship as “Legally Present Residents”. Since we became Certified Application Counselors and In-Person Counselors we have helped many LPRs. We’ve been slowed down by the Marketplace website that has made it very difficult for our LPR clients who find themselves unable to electronically verify their identity and proceed with the application.  We have identified three main ways that the website is unable to complete verification processes:

  1. Account Creation: The website depends on identity proofing questions in order to verify an applicants’ identity. These questions pull from credit history in order to produce questions unique to the applicant. Many LPRs are unbanked and are unable to be found by a traditional credit search for reasons such as employment history that depends on cash sources of payment, lacking lines of credit in the US, or simply just not enough time in the country. Variations of name placement across immigration documents also impact the ability for someone to be verified.
  2. Document VerificationIf someone is able to get through identity proofing, many have faced a yellow screen letting them know that electronic verification is not possible and to touch base within 24 hours. We have found this to be a permanent feature for our LPRs. We surmise that the website is not equipped to efficient verify an applicant’s citizenship information and gets stuck trying to verify the document information as it connects with the Department of Homeland Security. This usually occurs when an applicant inserts both alien number and document number.
  3. Eligibility DeterminationIf someone happens to get through account creation, if an LPR’s income is between 0-100% FPL and do not have legal permanent residency for five years or more, they are disproportionately likely to receive an incorrect eligibility determination. This determination usually points them to Illinois Medicaid, despite the fact that their legal status bars their eligibility.

We’re no different than outreach and enrollment teams across the country that have faced similar Marketplace glitches. Not only were we unable to help our clients who are immigrants through the easier, initial steps (that citizens were able to do) in the Marketplace application, but we also had to share the bad news with them that they should expect to wait additional weeks while we mailed out their documents and waited for verification. By late November, we saw applications for citizens submitted successfully while our LPR clients could not submit application because the electronic identify verification step didn’t work, and the application would literally close out. Our team started calling this “the yellow screen of death” because it meant that the client was completely locked out. Steps to resolve it ranged from starting a new application under a new user name, multiple times, sending paper applications to government offices in Kentucky, to calling the Call Center who hadn’t yet been trained or for whatever reason communicated incorrect information.

Because the neighborhoods we serve have a larger proportion of immigrants compared to other areas, our team felt compelled to figure out what was going on.  There is nothing more disheartening than the “yellow screen of death” the sixth time or trying to explain to one of our clients why they were told by Call Center representatives that they needed a Medicaid “denial letter” first before they could proceed with their Marketplace application.  We started tracking when and where the glitches occurred and we began piloting combinations of steps that would “trick” the system into accepting the supporting documentation.  We took a sample of 75 applications and with the permission of our clients, the applicants, we piloted a combination of steps that took them through the electronic application.  This week, we have been successful with 30 applications in 5 days’ time.  We are so happy to be able to tell our clients who are immigrants that we can process and successfully submit their application.

We have created a Process Workflow that describes why we are having the success we are. We have done an analysis overlaying application steps and tech-related misfires.  We are seeing interesting patterns and we have communicated this to our Government Marketplace counterparts.  You’ll find that attached here. As you can see, messy and complex, but so are our clients. We want to share what we are doing that works with other Enrollment Assisters experiencing the same problems.  We especially recognize that our clients who are immigrants carry a weightier burden of having to provide additional documentation than our clients who are US citizens.  Our clients who are immigrants experience additional steps that both elongate the difficulty of the application and its wait time, but their happiness in selecting a Qualified Health Plan and successfully submitting their own application electronically makes all the difference in our day.

My team has seen many of our original assists from October in the last few weeks. It’s been wonderful to see many of our community members and finally have a game plan for them. It’s been even more wonderful to see them enrolled in health plans. We’ve stuck it out this long together and we’re excited to get them onto the next step of this enrollment journey.