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In the Mix: Preparing to be Assisters

In the Mix: Preparing to be Assisters. Prepared by California Coverage and Health Initiatives (CCHI) June 2013. Our Agenda. Enrolling California’s Uninsured in Health Coverage Role of the Exchange in Shaping the Assister/Counselor R oles Enrollment Entity Roles and Responsibilities

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In the Mix: Preparing to be Assisters

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  1. In the Mix: Preparing to be Assisters Prepared by California Coverage and Health Initiatives (CCHI) June 2013

  2. Our Agenda • Enrolling California’s Uninsured in Health Coverage • Role of the Exchange in Shaping the Assister/Counselor Roles • Enrollment Entity Roles and Responsibilities • In-Person Assisters • Navigators • Certified Application Counselors • Which Role is Right for You? • Training Opportunities

  3. Enrollment System Guiding Principles CCHI believes California’s enrollment system should: • Build off the strengths of existing organizations • Involve small CBOs • Help assisters/enrollment counselors in their role

  4. California’s New Health Insurance Marketplace www.healthexchange.ca.govhttp://www.dhcs.ca.gov www.coveredca.com

  5. Who Will Need Help Enrolling in Coverage? • In 2014, 5.3 million Californians will be eligible to purchase insurance through the exchange : • 2.6 million will qualify for premium assistance • All will benefit from guaranteed coverage Source: Covered California

  6. Who Are California’s Uninsured? By ethnicity: Source: Covered California

  7. Enrollment Assistance in California Covered California has several types of Enrollment entities and Assister/Counselors: • Paid Assisters/Counselors • In-Person Assisters • Navigators • Unpaid Assisters/Counselors

  8. What Does the Enrollment Assistance Program Aim to Do? It engages Enrollment Entities and individual counselors who: • Conduct outreach and education to help people figure out their coverage options • Help consumers and small employers learn about and enroll in coverage • Help with the application process, translate materials and breakdown barriers Source: Families USA

  9. Who Can Be an Enrollment Entity? • Community Based Organizations (CBOs) and other consumer focused groups • Organizations with existing relationships with key eligible populations • Assisters/Counselors cannot: • Have conflicts of interest • Be health insurers or accept any form of payment from insurers related to enrollment

  10. What Will the Enrollment Entities and Enrollment Counselors’ Role Look Like? Covered California is in the process of determining: • What types of entities are eligible to be Navigators/IPAs • How they will be paid • Oversight and monitoring • HowEnrollment Assistance Program will work with the Medi-Cal population

  11. Program Overview

  12. In-Person Assistance Program (IPA) Overview Source: Covered California

  13. IPA Program Timeline Source: Covered California

  14. Navigator Requirements There are six major navigator requirements: • Provide outreach and education • Assist with enrollment • Expertise in eligibility and enrollment • Offer services in a fair and impartial manner • Provide referrals to ombudsmen or other consumer assistance programs • Make available information in a manner that is culturally and linguistically appropriate

  15. Navigator Program Overview Source: Covered California

  16. Navigator Program Timeline Source: Covered California

  17. Comparing IPA and Navigator Programs Source: Covered California

  18. Enrollment Assistance Application Process Eligible organizations and their employees may apply to register for the In-Person Assistance or Navigator Program by: • Submitting a completed application • Passing the Assister Fingerprinting and Criminal Record Check • Completing the required training established described in Section 6660 and pass the exam

  19. A Third Role: Certified Application Counselors (CACs) Covered California and DHCS will certify staff and volunteers to become CACs, who will: • Help consumers apply and enroll in Exchange coverage and Medi-Cal • Provide “the same core application assistance services” and have similar training requirements and conflict of interest standards to other enrollment assistance roles • Not be paid by the Exchange • Be unable to charge fees to consumers

  20. What is the Role of Insurance Agents? In California agents or brokers will: • Enroll individuals and small employers in qualified health plans and public programs • Assist individuals in applying for premium assistance/tax credits and cost-sharing reductions in exchanges

  21. Agents and Enrollment Entities Working Together • Nonfinancial working partnerships between agents and Enrollment Entities are encouraged • Regulations prohibit financial relationships between CEEs and CECs and anyone who holds a current license from California Department of Insurance

  22. Which Role to Play? Organizations will not be able to pursue both the IPA and Navigator role and should consider the following: • Does your organization want to offer IPA and collect a per successful application fee that is only funded until 2015? • OR • Go after a grant that is likely to be funded over a longer period of time?

  23. Requirements in Process Covered California has finalized the IPA portion of the Enrollment Assistance Program regulations. These provide guidance on: • Background checks, fingerprinting and liability insurance for individual assisters • Types of trainings and training topics • Relationships between agents and Certified Enrollment Entities Full-text of the regulations can be found here: http://www.healthexchange.ca.gov/BoardMeetings/Documents/June%2020,%202013/Enrollment%20Assistance%20Regulations%20(FINAL).pdf

  24. Training and Oversight Training standards for Certified Enrollment Entities and Counselors include: • Addressing the needs of underserved and vulnerable populations • Familiarity with qualified health plans (QHPs), public insurance programs, premium assistance/tax credit and cost sharing • Understanding eligibility and enrollment rules and procedures • Adherence to privacy and security requirements

  25. Enrollment Program Training Topics • Basic concepts about health insurance and the exchange, enrollment and individual responsibility • Outreach methods and strategies • Eligibility, application requirements and appeals • Enrollment procedures, processes and tracking systems • QHP/Medi-Cal/Healthy Families operations, plan options and benefit limits • Premium assistance/Tax Credits, deductibles and cost-sharing requirements • Understanding of cultural and linguistic standards and the needs of underserved and vulnerable populations • Access standards for individuals with disabilities • Referral to appropriate agencies for additional information • Code of Conduct and Ethics • Customer services standards • Privacy and security standards

  26. CCHI Member/Partner Areas of Expertise • Basic concepts about health insurance and the exchange, enrollment and individual responsibility • Outreach methods and strategies • Eligibility, application requirements and appeals • Enrollment procedures, processes and tracking systems • QHP/Medi-Cal/Healthy Families operations, plan options and benefit limits • Premium assistance/Tax Credits, deductibles and cost-sharing requirements • Understanding of cultural and linguistic standards and the needs of underserved and vulnerable populations • Referral to appropriate agencies for additional information • Access standards for individuals with disabilities • Code of Conduct and Ethics • Customer services standards • Privacy and security standards

  27. New Skill Sets • Basic concepts about health insurance and the exchange, enrollment and individual responsibility • Outreach methods and strategies • Eligibility, application requirements and appeals • Enrollment procedures, processes and tracking systems • QHP/Medi-Cal/Healthy Families operations, plan options and benefit limits • Premium assistance/Tax Credits, deductibles and cost-sharing requirements • Understanding of cultural and linguistic standards and the needs of underserved and vulnerable populations • Access standards for individuals with disabilities • Referral to appropriate agencies for additional information • Code of Conduct and Ethics • Customer services standards • Privacy and security standards

  28. Next Steps for Your Organization • Educate your Board and community partners about the programs • Consider your organizational structure and what role might work best for your organization • Develop a plan that includes training, goals and a readiness timeline • Complete the Enrollment Entity Interest form here: https://assisters.ccgrantsandassisters.org/ • Officially apply to become a Certified Enrollment Entity

  29. Reports Referenced in Presentation • Covered California, Assisters Program: In-Person Assistance and Navigator Webinars • Families USA, Interested in helping with enrollment in the federal insurance marketplaces? • State Health Reform Assistance Network, Designing Consumer Assistance Programs: Resources from the Field • CCHI and others, Health Benefit Navigator Credentialing, Training and Quality Assurance in California

  30. Who to Contact: INSERT your organization’s contact information HERE

  31. Feedback or Questions about this Presentation? Suzie Shupe Executive Director California Coverage & Health Initiatives 707-527-9213 sshupe@cchi4families.org www.cchi4families.org

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