Well, reading the first page – let’s see what happens

The first letter on the stack of ACA crap on my monday morning states that my wife qualified for care under either the Oregon Health Plan or the OHP Healthy Kids program.  It is a little disturbing that they do not know.  They also say that we’ll get an ‘enrollment packet’ soon which will have more information.  Why they can’t coordinate their mailings I don’t know, but that isn’t surprising, since they do not even know what program we qualify for… or do they…

The next paragraph state that, as of May 1st my wife qualifies for benefits starting Jan 1st – i’m glad that it took so many months to get the notification out.  What is wrong with these people – apparently we’ve had health care from them that’s backdated.  This would only be important if there were some other book-keeping policy like IRS for which it mattered, but there isn’t because we know that this is not ACA compliant and we have to pay the tax penalty because we have medicaid.

So wife qualifies for “Oregon Health Plan Citizen/Alien-Waived Emergent Medical (CAWEM) benefits.  CAWEM provides emergency medical care only for individuals who do not meet the immigration/alien status requirements.” – ok….. what the hell are “Emergent Medical Benefits” and what immigration/alien status requirements are they talking about.  She’s got a social security number, she has legal permanent resident status, so what status requirements are they talking about?

The next paragraph gives me list – it is clear – the requirements are spelled out in OAR 410-200-0115, 410-200-0215, 410-200-0235, 410-200-0240, 410-200-0305, 410-200-0310, 410-200-0315, 410-200-0400, 410-200-405, 410-200-0410, 410-200-0415, 410-200-0420, 410-200-0425, 410-200-0435, 410-200-0500, 410-200-0510, 410-120-1210.  So – it is up to me to review those pages of state statutes to determine what the hell they are talking about any why my wife does or does not meet “the requirements” – thankfully, as the final paragraph on this page states “If you disagree with any of the decisions above, you can challenge (appeal) this decision.  There is more information about appealing a decision at the end of this letter.”

So – this letter is addressed to people for whom the word “challenge” needs qualification and explanation, but the authors feel compelled to list a dozen state statues which are supposed to be clear enough to understand.  Even if you aren’t clear that ‘challenging a decision’ means ‘appealing a decision’ you should be able to understand 410-200-0xxx legislation – do I have that right?

I call the number 1-800-699-6075, and have been on hold during the entire time I’ve been writing – 11 minutes so far – and they say this is due to the “higher than normal call volume” – bullshit, this is normal call volume.  I have never not received a “higher than normal call volume” admonition – and what for?  Why am I 12 minutes on hold?  Because I’m trying to figure out why my wife does not meet the immigration/alien status requirements, since she is a legal permanent resident.

Let’s google a little and see what shows up, while we’re on hold, waiting for the assholes in salem to answer the damn phone.

I find this first: http://www.dhs.state.or.us/spd/tools/program/cawem.htm, which states…

Eligibility Requirements. To qualify for CAWEM, a person must meet all the nonfinancial and financial eligibility requirements for another medical assistance program, except the citizen/alien status and Social Security Number requirements. CAWEM applicants who are not documented (do not have a legal immigration status) are not required to declare or provide proof of their citizenship or immigration status.

Exception: There is no CAWEM eligibility under the OHP-CHP category or under HKC. If the basis for CAWEM eligibility is OHP-OPU, eligibility for CAWEM is subject to 461-135-1102.

I’m sorry – but this doesn’t seem to provide any useful information to me – it is opaque.  I know that the person must meet all non-financial and financial requirements (which is just another way of saying ‘requirements’ – it just has more words in it) except for the citizen/alien status and SSN requirements.  So, what I’ve gathered so far, is that there are some requirements somewhere that have to do with immigration – but I kinda already new that.

Let’s try google again – i’m still on hold trying to get a human to answer this question of “what the hell is the state talking about” – i keep googling, but the benefits manual cited above keeps coming up.  The text above is the best they can do.

Now…. well…. I’m still on hold and I just drove my wife to work and got home.  I have been on hold long enough for me to go out of the house, drive my wife to work, drop her off, and come home – we’re no closer to deciphering the above……

i’ve actually now taken a shit, shower, and I’ve dressed and driven to a coffee shop.  I’ve got a small coffee and I’m signed on to the star buck’s wifi.  I’ve been on hold for 51 minutes.  And all because I can’t figure out if there’s any sense to this first of the 22 pages of shit I’ve got to sift through thanks to fucking Obamacare.

FUCK YOU OBAMA – FUCK YOU MERKLEY – FUCK YOU KITZHABER.

so – let’s see if google can be faster than the government….  google helps me find this: http://apps.state.or.us/caf/fsm/08ma-k.htm

The Citizen/Alien-Waived Emergent Medical (CAWEM) program is available to individuals who meet all the nonfinancial and financial eligibility requirements for a medical assistance program except for citizen/alien status and Social Security number requirements. Individuals eligible for CAWEM are only eligible for emergency medical benefits, including childbirth (labor and delivery) services.

Exception: There is no CAWEM eligibility under the OHP-CHP or HKC category.

The worker does not need to make a decision about whether the person is in need of emergency medical treatment or childbirth services. Medical decisions are determined by the person’s medical provider pursuant to the administrative rules of the Office of Medical Assistance Programs. If a medical provider has questions about whether a condition is covered, they should contact the Division of Medical Assistance Programs (DMAP) at 800-336-6016.

CAWEM medical assistance is authorized under the program (BCCTP, MAA, MAF, EXT, OHP, OSIPM and SAC) for which the person would qualify if they met the citizen/alien requirement. When benefits are established, CAWEM clients receive a medical coverage letter stating:

 

“COVERAGE IS LIMITED TO EMERGENCY MEDICAL SERVICES. LABOR AND DELIVERY SERVICES FOR PREGNANT WOMEN ARE CONSIDERED AN EMERGENCY.”

A child born to a CAWEM mother is an assumed eligible newborn (AEN). Add the child’s medical eligibility to the case using the AEN N/R code.

Specific Requirements; Citizen/Alien-Waived Emergent Medical (CAWEM): 461-135-1070 
OHP-OPU; Effective Dates for the Program: 461-135-1102

Most noncitizen children who have legal immigration status but who do not meet the financial eligibility requirements of a Medicaid or CHIP program are eligible for HKC if their family income is at or below 301 percent FPL. (Refer to Noncitizens Worker Guide #1: Noncitizen Charts (NC-WG#1).

which again, I’m just not smart enough to find as an easy read.  I understand that most united states citizens are smart enough to understand this with ease – but sadly I am just not that smart.  Perhaps there is a 2nd class citizen status I should try to pursue – a sort of lesser, legally confused american citizen.

Let’s try looking at the OAR – maybe reading the OAR itself will be more effective….  I locate quickly, in under a minute, that 410-200-0240 is about CAWEM…. 

PRESTO – at 59 minutes of hold I get a triage operator who has no idea what I’m talking about, is only vaguely aware of 401-200-0240, hears the word eligibility and transfers me via an “in-house transfer” to the eligibility department.  The most impressive thing she tells me is that she has a special transfer path that avoids waiting in line again.

I’m on hold for only a few minutes this time, but get someone from eligibility.  She indicates that you have to live in Oregon for 5 years before you are considered a first class legal permanent resident.  Because we arrived a year and a half ago, my wife only qualifies for non-compliant medicaid help that is equivalent to the policy that we had before the state got involved.  When I inquire as to whether or not she has to pay the tax penalty, this person says she has no knowledge and passes me off to another agent.

After a few minutes on hold I go again through the pre-amble of what’s your name, are you related to the person you’re calling about, reading the client-id number, getting it wrong, reading it again, verifying some information and then getting to “ok, how may I help you.” – she says that she’s the wrong agent to discuss this with, as she doesn’t know anything about eligibility and the ACA, but suggests that I call CoverOregon or the Governor’s Office – both of which also have no real understanding of the ACA.

After an hour and 10 minutes, I express my frustration that there is no one at the OHA who apparently has any information – that I’m being passed around and holding for hours, and that this is unacceptable.  She apologizes and says “you have to understand, this is all new and we’re all trying to figure it out – i wish i could help, but we just don’t know”.  So an hour and 10 minutes on the phone, three agents, and we still can not verify that my wife has to pay the tax penalty and can only receive non-compliant medicaid.  We agree that there is no point to continuing, that she is useless, and we hang up.

This is what the ACA means to me.

The CAWEM is identical to the non-compliant health insurance I had – the only thing that the ACA has provided me, in this regard, is aggravation and paperwork – it has taken me, at great cost, full circle back to where I was before the government got involved.

Fuck you Obama – Fuck you Merkley – Fuck you Kitzhaber – Fuck you Oregon – Fuck you Oregonians – Fuck you Americans – Fuck you all.  Give me the freedom to take care of my fucking health care without your intervention you incompetent washington jackasses!

Standard

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s