Get Covered Tennessee

1. A coordinatedstatewideinitiativetohelpuninsuredTennesseansenroll in new healthcarecoverageoptions GetCovered Tennessee Beth Uselton Program Officer Baptist Healing Trust Lisa Pote Senior Vice President Seedco of the Midsouth

2. 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 BHT leadership to propel the project as a private collaborative effort • Baptist Healing Trust was tasked with: • Recruiting an advisory council • Convening potential community partners • Conducting preliminary strategic planning • Researching best practices

3. Advisory Council

4. Where are we today? • Monthly meetings of the Advisory Council • Strategic planning • Funder briefings • Identified lead agency – Seedco • Recruiting potential community partners • For Navigator proposal & other opportunities to partner • Survey of 200+ non-profit organizations

5. Over 900,000 uninsured Tennesseans will be eligible for health insurance under the Patient Protection and Affordable Care Act* January 1, 2014

6. The “Tennessee plan” Private insurance Cost-sharing for certain visits No wrap-around services Commercial 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: Approval from Center for Medicaid & Medicare Services (CMS) Votes from Tennessee General Assembly to appropriate funding

7. Linking Uninsured Tennesseans to Coverage FPL 400% 300% 200% 100% Unsubsidized 525,000 Subsidized 138% Remain uninsured if no deal 400,000 0% 0% People with Disabilities Children Pregnant Women Parents Adults w/o Children Undocumented Immigrants ■ TennCare & CoverKids  Marketplace (Exchange) ■ Uninsured  Tennessee Plan

8. Who is eligible for help? * 2013 Poverty Levels

9. Case Study #1 The Jones 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 • Married, no children • Own a small business • Purchase their own health insurance • Annual combined income = $60,000

10. Case Study #2 The Gonzalez Family 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 • Family of four • Both parents work full-time • No insurance offered at work • Annual combined income = $50,000

11. Case Study #3 The Reynolds Poverty Level: 96% Coverage Option: Marketplace, full price Annual premium = $6,036 (40% of income) No TennCare, No Subsidies • Couple, no children • Jean works full-time for minimum wage: $7.25 / hour $15,080 / year • No health insurance offered at work

12. Who is left uncovered? • Undocumented immigrants • Estimated 120,000 to 140,000 undocumented immigrants living in TN1 • Those left uncovered without TennCare Expansion • Estimated 180,000 to 225,000 2 • Childless adults • Parents of children who are on TennCare but do not qualify for coverage themselves • Those who neglect or refuse to enroll Sources: "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>. University of Memphis; BCBST; American Journal of Managed Care; Division of Healthcare Finance and Administration.

13. How will people enroll? Individuals & Families Federal Health Insurance Marketplace Qualified Health Plans IRS INS SSA To verify income, social security benefits and citizenship status and determine tax credit Small Businesses Small Business Group Health Plans

14. No wrong door

15. Single, streamlined application 21 page application reduced to 3 pages Step 1: Tell us about yourself Step 2: Current job and income information Step 3: Your health coverage Step 4: Sign & submit Forms available online: http://www.cms.gov/CCIIO/Resources/Forms-Reports-and-OtherResources/ Downloads/AttachmentC_042913.pdf

16. Easy Shopping Experience • Easy-to-read format • Glossary of terms (deductible, co-pay, etc) • Costs & benefits in plain English on two sheets of paper

18. The Challenge The majority of uninsured Americans don’t know the health reform law will help them. 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 75% of the newly eligible want in-person assistance to learn about and enroll in coverage. Source: Enroll America Research, November 2012

20. Consumer Assistance Public Education & Community Outreach How will they know? Where will they turn for help?

21. Who are the uninsured in Shelby County? 142,645 uninsured residents These estimates are available on the CMS website at http://cms.hhs.gov/OutreachandEducation/Outreach/HIMarketplace/Census-Data-.html. CMS and ASPE used the Census Bureau’s 2011 American Community Survey (ACS) for the analysis, and all estimates represent the eligible uninsured population aged 0-64.

22. Who are the uninsured in Shelby County? These estimates are available on the CMS website at http://cms.hhs.gov/OutreachandEducation/Outreach/HIMarketplace/Census-Data-.html. CMS and ASPE used the Census Bureau’s 2011 American Community Survey (ACS) for the analysis, and all estimates represent the eligible uninsured population aged 0-64.

23. Who are the uninsured in Shelby County? These estimates are available on the CMS website at http://cms.hhs.gov/OutreachandEducation/Outreach/HIMarketplace/Census-Data-.html. CMS and ASPE used the Census Bureau’s 2011 American Community Survey (ACS) for the analysis, and all estimates represent the eligible uninsured population aged 0-64.

24. Who are the uninsured in Shelby County? These estimates are available on the CMS website at http://cms.hhs.gov/OutreachandEducation/Outreach/HIMarketplace/Census-Data-.html. CMS and ASPE used the Census Bureau’s 2011 American Community Survey (ACS) for the analysis, and all estimates represent the eligible uninsured population aged 0-64.

25. Who are the uninsured in Shelby County? These estimates are available on the CMS website at http://cms.hhs.gov/OutreachandEducation/Outreach/HIMarketplace/Census-Data-.html. CMS and ASPE used the Census Bureau’s 2011 American Community Survey (ACS) for the analysis, and all estimates represent the eligible uninsured population aged 0-64.

26. Who are the uninsured in Shelby County? 97,027 have a full-time worker in family These estimates are available on the CMS website at http://cms.hhs.gov/OutreachandEducation/Outreach/HIMarketplace/Census-Data-.html. CMS and ASPE used the Census Bureau’s 2011 American Community Survey (ACS) for the analysis, and all estimates represent the eligible uninsured population aged 0-64.

27. And we only have 97 days until October 1, 2013

28. Lead Agency SeedCo of the MidSouth, based in Memphis Who 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.

29. The Problem: Enrolling over 500,000 people (without Medicaid expansion) 100-400% of poverty $1.4 million is not going to do it Because of Medicaid expansion decisions, there will be a LOT of people who are not eligible for the Marketplace that will need other assistance Lots of confusion, mistrust of government and the ACA Political environment of pressure to get it right

30. The Opportunity: Creating a framework from which a broad range of stakeholders and engage and interact with insurable individuals A willingness on the part of providers to step up without Navigator funding Leverage the strengths of all to complement each other to reach as many people as possible

31. Seedco Navigator Grant Summary: $1.3 million 18.5 Navigator positions Focus on high-population areas urban areas with swing navigators through high-density rural areas. Emphasis on connecting navigators with community-based CACs… Natural points of entry for target populations. Funding announcements made August 15

32. East Tennessee 334,218 Uninsured 6.5 Navigators West Tennessee 227,278 Uninsured 6 Navigators Middle Tennessee 318,484 Uninsured 6 Navigators

33. What is a Navigator? Individual or entity that: Conducts community outreach activities to identify uninsured individuals and small businesses Raises public awareness about new marketplace options 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

34. 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

35. 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.”

36. Training Standards <30 hours of online training Navigators & CACs must be trained in: Qualified Health Plan options in the Exchange Affordability programs Premium tax credits Cost-sharing subsidies Eligibility & benefits for TennCare & CoverKids Continuing Education Required for Certification & Recertification

37. Certified Application Counselors New consumer assistance in the Tennessee marketplace Navigators 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

38. Consumer Assistance Carrier commissions for QHPs no commission for TennCare/CoverKids No funding mechanism built in Federal grants Private funding?

39. Navigator Planning/Foundational Assumptions:500,000 people will get enrolled in a lot of different places.

40. What role can medical providers play in outreach and enrollment? • 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

41. What role can medical providers play in outreach and enrollment? 2. Identify staff to help as Certified Application Counselors (CACs): • Social Workers • Intake / Front Office staff • Case Managers

42. Elements of a Successful Outreach and Enrollment Campaign: Focusing on existing strengths. Creating a network that is scaleable for when Medicaid is expanded in some form (Tennessee Plan, etc…). Creating a culture of: communication and information dissemination best-practice sharing continues learning/improvement across the state. Ensure that every partner is participating, in someway, that has a vested interest in seeing the success of successful enrollment effort.

43. What’s Happening THIS Summer • Traveling across the state • Presentations to local stakeholder groups • Collaborations that will improve outcomes for success. • Building a fundraising strategy that will advance and contribute to success. • Increasing capacity of communities to engage in broader outreach and enrollment efforts.

44. 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: https://app.e2ma.net/app2/audience/signup/1741403/1724393/?v=a 3. Contact Seedco: navigatortn@seedco.org (901) 528-8341