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Key date for new health exchange is Dec. 15

Scott Bauer, Associated Press

MADISON, Wis. (AP) -- The new online exchange where people can buy health insurance opens Tuesday, but advocates for Wisconsin residents who will be shopping for coverage say Dec. 15, not Oct. 1, is the date that most concerns them.

That's the cutoff for coverage beginning in January. The date is especially important for 92,000 people being forced off Wisconsin's BadgerCare Medicaid program at the end of the year. If they don't meet the deadline, they'll have no insurance at the start of the new year.

There could be a "big bottleneck" around that December deadline, worries Jon Peacock, research director of the Wisconsin Council on Children and Families.

"Waiting until then is really going to be a mess," he said.

To help alleviate a possible crunch, the state sent notices last week to those expected to lose Medicaid coverage, telling them they may not be covered. The letters will be followed up by phone calls in October and a second notice in late November.

The word for some, however, won't be final.

That's because the state is not using 2014 definitions of income and household size required under the federal Affordable Care Act, also known as "Obamacare." Some people who don't qualify for Medicaid currently will be told by the state they need to buy insurance through the exchange, even though starting in January they may continue to be eligible for Medicaid based on the new guidelines.

State officials and advocates are advising anyone who receives a notice to go to the marketplace now for a determination of their Medicaid eligibility. The federally run exchange uses the 2014 criteria and will direct them back to the state for Medicaid services if they qualify.

"Our goal is to have uninterrupted coverage for members, so we are pushing for individuals to enroll by Dec. 15," state Department of Health Services spokeswoman Stephanie Smiley said.

The soonest anyone who misses the Dec. 15 deadline could have coverage begin is Feb. 1. Open enrollment continues through March 31. After that, unless there is a change in family status, employment, income or other qualifying event, no one can sign up for insurance until October 2014.

The online exchange, or marketplace, is supposed to offer a consumer-friendly way to buy health insurance while forcing insurers to compete for business. Consumers can apply online at healthcare.gov, through a call center, in person or through the mail.

Many of those losing BadgerCare coverage may not understand the changes, think they can't afford insurance or won't attempt to get coverage until they need to see a doctor, said Joy Tapper, executive director of the Milwaukee Health Care Partnership, a group that works to help low-income people get insurance coverage.

Along with the roughly 92,000 people losing Medicaid coverage, about 200,000 people who currently buy their own health insurance and up to 470,000 who are uninsured are expected to shop for plans on the exchange.

Republican Gov. Scott Walker opposes the ACA and left it to the federal government to run the exchange, but he has a stated goal of reducing the number of uninsured people in Wisconsin by half. To help do that, his administration has been working with outside groups, local government health departments and others to help sign people up for insurance on the exchange.

Walker also reduced income eligibility under the state's BadgerCare Medicaid program from 200 percent of poverty to 100 percent. Wisconsin's income eligibility limit for Medicaid starting in January will be $11,500 for an individual or $23,550 for a family of four.

Wesley Prater, a senior health policy analyst at Georgetown University, said he was concerned that terminating some people's BadgerCare coverage at the same time the exchange goes into effect, combined with questions over eligibility, will only create confusion.

"You have to remember a lot of these people have never purchased health insurance before in their life," Prater said. "On top of this short timeline, this is a completely new process for them."