meeting the enrollment challenge beth uselton program officer statewide meeting of tennessee’s...
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Meeting The Enrollment Challenge
Beth UseltonProgram Officer
Statewide Meeting of Tennessee’s Charitable ClinicsMay 31, 2013
Over 900,000 uninsured Tennesseans will be eligible for health insurance under the Patient
Protection and Affordable Care Act*
January 1, 2014
How will they be covered?
Total 925,000
* IF Governor Haslam can get approval from CMS and the Tennessee General Assembly
The “Tennessee plan”Private insuranceCost-sharing for
certain visitsNo wrap-around
servicesCommercial
standards for appeals of denial
Payment reform
On March 27th, Governor Haslam announced his intention to develop a plan to use Medicaid funds allocated to Tennessee under the ACA to provide private insurance to uninsured Tennesseans under 100% of the federal poverty line.
To implement the plan, he will need:1.Approval from Center for Medicaid & Medicare Services (CMS)2.Votes from Tennessee General Assembly to appropriate funding
FPL
400%
300%
200%
100%
FPL
400%
300%
200%
100%
Children Undocumented Immigrants
Adults w/o Children
People with Disabilities
ParentsPregnant Women
0% 0%
Subsidized
Unsubsidized
Linking Uninsured Tennesseans to Coverage
400,000
525,000
Remain uninsured if
no deal
138%
Who is eligible for help?
* 2013 Poverty Levels
Case Study #1
The Jones
• Married, no children• Own a small business• Purchase their own health
insurance• Annual combined income
= $60,000
Poverty Level: 382%
Coverage Option(s): Marketplace
Maximum annual premium =
$6,036 / year
(9.5% of income)
Subsidies:
Premium Tax Credit = $336
No cost-sharing subsidies
Maximum out of pocket = $5,700
Poverty Level: 382%
Coverage Option(s): Marketplace
Maximum annual premium =
$6,036 / year
(9.5% of income)
Subsidies:
Premium Tax Credit = $336
No cost-sharing subsidies
Maximum out of pocket = $5,700
Case Study #2
The Gonzalez Family
• Family of four• Both parents work full-time• No insurance offered at
work• Annual combined income
= $50,000
Poverty Level: 209%Coverage Option: Marketplace
Regular annual premium = $9,869
Maximum annual premium they will pay = $3,314
(6.63% of income)Subsidies: Premium Tax Credit = $6,555 + Cost-sharing Subsidies
Poverty Level: 209%Coverage Option: Marketplace
Regular annual premium = $9,869
Maximum annual premium they will pay = $3,314
(6.63% of income)Subsidies: Premium Tax Credit = $6,555 + Cost-sharing Subsidies
Case Study #3
The Reynolds
• Couple, no children• Jean works full-time for
minimum wage:
$7.25 / hour
$15,080 / year• No health insurance
offered at work
Poverty Level: 96%Coverage Option: Marketplace, full price
Annual premium = $6,036(40% of income)
No TennCare, No Subsidies
Poverty Level: 96%Coverage Option: Marketplace, full price
Annual premium = $6,036(40% of income)
No TennCare, No Subsidies
Who is left uncovered?1. Undocumented immigrants
– Estimated 120,000 to 140,000 undocumented immigrants living in TN1
2. Those not covered due to Governor’s decision not to expand TennCare– Estimated 180,000 to 225,000 2
– Childless adults– Parents of children who are on TennCare but do
not qualify for coverage themselves
3. Those who neglect or refuse to enroll
Sources:1)"Distribution of Illegal Aliens by State." Federation for American Immigration Reform (FAIR), 2011. Web. 28 May 2013. <http://www.fairus.org/issue/how-many-illegal-immigrants#end>.2)University of Memphis; BCBST; American Journal of Managed Care; Division of Healthcare Finance and Administration.
Test drive the calculator
Kaiser Family Foundation website:
www.kff.org/interactive/subsidy-calculator/
KFF offers many interactive tools, fact sheets, graphs & timelines
Small Businesses
Individuals & Families
SSASSASSASSA
Qualified Health Plans
Federal Health
Insurance Marketplace
How will people enroll?
IRSIRSIRSIRS INSINSINSINS
To verify income, social security benefits and citizenship status
and determine tax creditSmall Business
Group Health Plans
No wrong door
13
Single, streamlined application
Step 1: Tell us about yourself
Step 2: Current job and income information
Step 3: Your health coverage
Step 4: Sign & submit
21 page application reduced to 3 pages
Forms available online:http://www.cms.gov/CCIIO/Resources/Forms-Reports-and-OtherResources/ Downloads/AttachmentC_042913.pdf
Easy Shopping Experience
• Easy-to-read format
• Glossary of terms (deductible, co-pay, etc)
• Costs & benefits in plain English on two sheets of paper
The ChallengeThe majority of uninsured Americans don’t know
the health reform law will help them.
75% of the newly eligible want in-personassistance to learn about and enroll in coverage.
Source: Enroll America Research, November 2012
78% of the uninsured don’t know about the new health insurance exchanges
83% of people who could be eligible for the new Medicaid expansion don’t know about it
And we only have 122 days
until
October 1, 2013
How will they know?Where will they turn for help?
Consumer Assistance
Public Education & Community Outreach
Help, I Need Somebody!
Get Covered TennesseeA coordinated statewide initiative to help
uninsured Tennesseans enroll in new health care coverage options
Working together: We all play a role in a
successful enrollment effort!Insurers
Hospitals
Consumer groups
Retailers
Community Health Centers
Drug Companies
Civic Groups
Labor
Communities
of Color
Faith-based groups
Business
Background• Project launched in November 2012 as a public/private partnership with
the Tennessee Insurance Exchange Planning Initiative to provide consumer assistance for the state-based marketplace
• In December 2012, Governor Haslam announced that his administration would not administer the exchange in Tennessee
• Baptist Healing Trust was tasked with:•Recruiting an advisory council
•Convening potential community partners
•Conducting preliminary strategic planning
•Researching best practices
Name Organization Position
Nancy Anness, APN St. Thomas Health Vice-President of Advocacy, Access and Community Outreach
Ashley Arnold Insurors of Tennessee General Counsel & Chief Operations Officer
Pete Bird Frist Foundation Chief Executive Officer & President
Denise Bollheimer Bollheimer ConsultingCEO (Founder & former Chair, Healthy Memphis Common Table)
Rae Bond Chattanooga Medical Society and Project Access Executive Director
Dr. Brian Bonnyman, MD Cherokee Health Systems Family Physician
Dr. Teresa Cutts, PhDCenter of Excellence in Faith & Health, Methodist Le Bonheur
Director of Research & Innovation; (Congregational Health Network)
Brian Haile, JD Jackson Hewitt
Senior VP for Health Policy (Former Director of the Health Insurance Exchange Planning Initiative for the State of TN)
Tavarski Hughes Blue Cross Blue Shield of TN Public Policy Liaison
Dr. Carole Myers, PhD, RN University of Tennessee College of Nursing
Associate Professor (Former Co-Director of UT Center for Health Policy & Services Research)
Elliott Moore Mountain States Health Alliance; Project Access Director of Community & Government Relations
Dr. Ken Robinson, MD Shelby County Mayor's OfficePublic Health Policy Advisor (Former Commissioner of Health for State of TN)
Dr. Cathy Self, PhD Baptist Healing Trust Chief Executive Officer & President
Maitane Tidwell Inclusive Communications President
Carol Westlake Tennessee Disability Coalition; Executive Director (also Chair of Middle TN Safety Net Consortium)
Pam Wright, JD West Tennessee Legal Services Attorney, Elder Law Specialist
Dr. Jan Young, PhD, NP Assisi Foundation of Memphis Executive Director
Advisory Council
• Monthly meetings of the Advisory Council• Strategic planning to develop single consortium
proposal for Tennessee Navigator grant• Recruiting potential community partners
– For Navigator proposal & other opportunities to partner– Survey of 200+ non-profit partners
• Funder briefings• Lead applicant identified
Where are we today?
SeedCo of the MidSouth, based in MemphisWho is Seedco?
Seedco is a national nonprofit intermediary with more than 25 years of experience in managing complex, multimillion-dollar federal contracts that connect low-income individuals and families with the resources they need to be successful.
What Seedco Does:
We develop, implement and learn from model programs that combine evidence-based research and innovative ideas with outcome-driven management practices.
Lead Agency Identified
•Seedco builds partnerships with key community stakeholders such as government, businesses and nonprofits with the goal of establishing community, statewide and national networks of organizations to generate economies of scale and improve overall outcomes.
•Seedco initiatives reflect the highest regard for both administrative and programmatic integrity.
•Seedco has over ten years of experience of leveraging community networks to improve access to online benefits for adults and children in need in the Memphis area.
•Seedco recently won an award to run the Upper Eastern Seaboard Navigator project for Maryland’s Health Insurance Marketplace.
Seedco’s Qualifications for the Navigator Program
Target Group? Employees Insurable and
Uninsurable Individuals
InsurableIndividuals
Where? Work Places Health Places Life Places
Examples of Locations
Less than 50 employees HospitalsFQHCs
Charity centersDoctor’s offices
Technical collegesTax prep centersLarge box stores
SchoolsNeighborhoods
CBOs
Who Will Enroll?Brokers Navigators CACs Navigators and CACs
Funded How?
Commissions
Federal Funding
Private funds, other fundraising
Navigator funds and foundation funding
Navigator Planning/Foundational Assumptions:
500,000 people will get enrolled in a lot of different places.
What is a Navigator? Individual or entity that:
1) Conducts community outreach activities to identify uninsured individuals and small businesses
2) Raises public awareness about new marketplace options
3) Facilitates enrollment of eligible individuals and small businesses into Qualified Health Plans (QHPs) through the health insurance marketplace
Have or able to establish relationships with Employers & employees Consumers, including uninsured & underinsured Self-employed individuals
What is Required?Navigators must have expertise in:
eligibility & enrollment rules & procedures the needs of underserved & vulnerable populations privacy & security standards
Must be capable of carrying out: facilitating selection of Qualified Health Plans providing fair, accurate, impartial information
culturally & linguistically appropriate accessible to individuals with disabilities
providing referrals for grievances
Certified Application Counselors(CACs)
Appeared in regulation in January 2013: “…trusted community-based organizations,
providers, or other organizations with expertise in social service programs.”
“…employees and volunteers of organizations, which may include health care providers and entities, as well as community-based organizations, among other organizations.”
Certified Application Counselors(CACs)
Must register with the Marketplace and Receive training & certification Comply with disclosure & privacy standards Comply with state laws related to conflict of interest
standards Not funded by the Marketplace May be paid by Medicaid (TennCare) or
through private funding sources
New consumer assistance in the Tennessee marketplace
Navigators Certified Application Counselors
Community outreach Public education
Distribute fair & impartial information
Facilitate enrollment Qualified health plans TennCare CoverKids
Provide referrals for grievances
Distribute fair & impartial information
Facilitate enrollment Qualified health plans TennCare CoverKids
Provide referrals for grievances
Training Standards
Navigators & CACs must be trained in:
Qualified Health Plan options in the ExchangeAffordability programs
Premium tax creditsCost-sharing subsidies
Eligibility & benefits for TennCare & CoverKids
<30 hours of online
training
Continuing Education
Required for Certification & Recertification
Consumer Assistance Carrier commissions for QHPs
No funding mechanism built in
Federal grants
Private funding?
no commission for TennCare/CoverKids
What role can clinics play in outreach and
enrollment?1. Inform your clients
– Tell them about their new options• There will be new, affordable options available for people without
insurance.• All insurance plans will have to cover doctor visits, hospitalizations,
maternity care, emergency room care, and prescriptions. • Financial help is available so you can find a plan that fits your budget.• All insurance plans will have to show the costs in simple language with
no fine print.
– Provide referrals for enrollment assistance
What role can clinics play in outreach and
enrollment?
2. Identify staff to help as Certified Application Counselors (CACs):– Social Workers– Intake / Front Office staff– Case Managers
Who is left uncovered?1. Undocumented immigrants
– Estimated 120,000 to 140,000 undocumented immigrants living in TN1
2. Individuals and families under 100% of poverty not covered due to Governor’s decision not to expand TennCare– Estimated 180,000 to 225,000 2
• Childless adults• Parents of children who are on TennCare but do not
qualify for coverage themselves
3. Those who neglect or refuse to enrollSources:1)"Distribution of Illegal Aliens by State." Federation for American Immigration Reform (FAIR), 2011. Web. 28 May 2013. <http://www.fairus.org/issue/how-many-illegal-immigrants#end>.2)University of Memphis; BCBST; American Journal of Managed Care; Division of Healthcare Finance and Administration.
What else do clinics need to consider?
3. Evaluate your new operational considerations– What proportion of your client population is uninsured?
• How many will be eligible for new coverage options?
– Do you contract with commercial carriers or TennCare?• Would you decide to if the majority of your patients were to
become insured?
– What population could you serve with your existing infrastructure?
What is the role of Baptist Healing Trust now?
• Convener– Stakeholders - Advisory council– Funders - Community partners
• Technical assistance– Conduit of Information– Policy Analysis
• Liaison to federal & state agencies
Timeline
42
Open Enrollment media blitz
events
Oct
ober
1, 2
013
Mar
ch 3
1, 2
014
Dec Ja
n
Feb
Mar
Sep
Aug
Jul
June
MayAp
rSta
keholder Brie
fing
Naviga
tor/C
AC Tra
ining
s Sta
tewide
Naviga
tors
& CACs rec
ruite
d
Nav
igat
or P
ropo
sal D
eadl
ine
BHT launch
es pro
ject
Nov
Gov
. ann
ounc
es
no s
tate
exc
hang
e
Fede
ral F
OA
Rele
ased
Nav
igat
or A
war
ds
Advisory
Council Esta
blished
Develo
p Comm
unity
Partn
ersh
ips
Lead
agen
cy id
entified
Are you interested in partnering with Get Covered Tennessee?
1. Complete the Navigator Survey for Community Partners (and complete the CAC section):
https://www.surveymonkey.com/s/navigatorsurveybht
2. Join our email list for updates:
http://oi.vresp.com/?fid=9311bf1115
3. Contact Seedco:
(901) 528-8341
Want to learn more?
ACA for Community Health Clinics Workshop:
Monday, August 26th 1:30-3:30pm CST
Center for Nonprofit Management
Beth UseltonProgram OfficerBaptist Healing [email protected](615) 284-8271 ext.12