HICAP presents LIS Strategies

1. HICAP presents LIS Strategies The Health Insurance Counseling and Advocacy Program Tatiana Fassieux, HICAP Program Manager Butte, Colusa, Glenn, Plumas and Tehama Counties Anne Kasper, HICAP Program Manager Riverside, San Bernardino, Inyo and Mono Counties Margaret Reilly, HICAP Program Manager El Dorado, Placer, Nevada, Sacramento, San Joaquin, Sierra, Sutter, Yolo and Yuba Counties Dori Silveria, HICAP Program Manager Kings and Tulare Counties

2. L I S What is it? Why is it? Where is it needed? Can we get there from here???

3. Background LIS Program is designed to help Low-income beneficiaries. • Full or partial subsidies of premiums and • Reductions in cost-sharing for the Medicare prescription drug plans • Amounts in cost-sharing vary based on the income level and assets of the beneficiary.

4. Certain groups of low-income Medicare beneficiaries automatically qualify (are “deemed eligible”) for the LIS program. • Full-benefit dual eligible individuals • Medicare beneficiaries who are recipients of Supplemental Security Income benefits • Participants in the Medicare Savings Programs (MSP) QMB - Qualified Medicare Beneficiaries, SLMB -Specified Low-Income Medicare Beneficiaries, QI - Qualifying Individuals

5. What about beneficiaries with low incomes and limited resources who do not fall into one of the automatic subsidy eligibility groups? • That would be the targeted population CMS is trying to enroll … • … with our help!

6. Congress asked that “…the Secretary (of Health & Human Services) Leavitt shall report on best practices in the successful enrollment of low-income beneficiaries” into the Medicare prescription drug benefit program (Part D). • Which particular activities (outreach, partnerships, involvement of key organizations, or others) and at what level (federal, state, local) contribute to effectively enrolling and transitioning … low income beneficiaries into Part D and the Low-Income Subsidy (LIS) program.

7. Now that is a good question …

8. What’s in a name? There is a reluctance to identify with the Low Income label. • Extra Help? • Limited Income Subsidy? • Extra Financial Help? Would a rose by any other name still smell as sweet?

9. How does LIS work? • Beneficiaries eligible for the full subsidy received 100% premium subsidy. • For beneficiaries eligible for the partial subsidy, the law sets the sliding scale premium percentage (100%-25%) • Cost sharing refers to the beneficiary’s expenses (deductible and copayment or coinsurance) in the Part D plan, with the exception of the premium. • Beneficiaries eligible for the full premium subsidy have no deductible or copayment amounts.

10. How does LIS work? • For beneficiaries eligible for the partial subsidy: Deductible in 2009 is $60; Coinsurance is 15%. • Copayment is a fixed dollar amount • ($2.40 for generic or preferred multiple source; • $6.00 for other drugs in 2009) • Coinsurance is a percentage.

11. Success Factors a k a Challenges and Opportunities • Identify – and then locate - the target population • Create appropriate messages • Collaborate with CBOs and FBOs • Facilitate Enrollment in LIS

12. From the Inland Empire: • Target areas for outreach indicated as high on the zip code list for residents who are potentially eligible, but who haven’t yet applied. • Target churches, organizations serving low-income clients (like public health clinics, nutrition sites, home-delivered meal programs, food banks). • Do not discriminate – make it a habit for counselors and outreach personnel to mention that extra help is available through Social Security if you fit into the guidelines. •  Consider hiring volunteer counselor to follow up by phone with people given LIS info and an application during a counseling session.  • After 6 to 8 weeks they would be contacted again to determine if they had gotten a reply about their eligibility.

13. From the Capitol Region … Dedicated LIS On-Line Assistance 9-County Outreach Effort began July 2008 limited success LIS mentioned in every Community Presentation • New Counseling Session protocol: • Always ask income questions • Make appropriate notations on Intake Form • Follow-up with either • Immediate on-line assistance, • LIS packet, or • Referral to central office for follow-up

14. The University setting in combination with vast rural areas: • Beating the Bushes Campaign • Phase 1: Design • Have dedicated counselor for outreach and counseling • Prepare unique flyers to target clients in non-traditional locations: Laundromats, grocery stores, car washes, banks, homeless shelters, bars, beauty shops, etc. • Identify partners • Design data collection tools • Different color intake • Ask how client heard of us – specifically, what outreach medium they say or heard

15. Phase 2: Outreach • Mail outreach materials to partners • Produce TV commercial to run during programs viewed by potential candidates • Phase 3: Data Collection • Using existing reporting methodologies, track counselor and counseling time, number of intakes and outreach events accomplished with LIS/MSP funding. • Evaluate results for future projects.

16. Tools from Tulare • Operating under the auspices of Tulare County Health and Human Services • Affiliation opens doors Rural Service Area • Health Fairs are important • Churches • Food Banks • Mobile Home Parks • With surprising frequency, often this emphatic comment is heard: • “I’m not interested.”

17. COLLABORATION IS KEY Rely on Community-Based and Faith-Based Organizations to Implement Best Practices. CBOs and FBOs can: • Identify beneficiaries through Public Benefit Program lists. • Identify and educate beneficiaries by reaching them during their daily activities. • Provide insight into strategies most likely to work locally. • Effectively tailor messages to their local communities. • Time Community Outreach to coincide with activities already planned for specific beneficiary populations.

18. The future is now … • The on-line LIS application (developed by SSA), • Medicare Prescription Drug Plan Finder (developed by CMS), • BenefitsCheckUp (developed by NCOA) • The use of on-line application and plan-finder tools is impossible without a technological infrastructure, such as computers, Internet access, and printers. • Technology investments are not one-time purchases but required regular funding to update and maintain.

19. A chicken in every pot • Still a good idea. • But for effective enrollment in LIS • A computer with internet access is mandatory.

20. Our Goals: • Build collaborative partnerships that engage our mutual constituency • Create a message to which our target audience can relate • Enroll every eligible beneficiary, in every HICAP region, in the LIS program.

21. The sweet smell of success … Can be found only with adequate planning and collaboration