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Tapping the Community Based Infrastructure to Maximize Outreach and Consumer Assistance

Tapping the Community Based Infrastructure to Maximize Outreach and Consumer Assistance . Indiana ACA Symposium March 15, 2013 Tricia Brooks. Many Will Need Individualized A ssistance. Becoming aware of new options and personal responsibility to have coverage

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Tapping the Community Based Infrastructure to Maximize Outreach and Consumer Assistance

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  1. Tapping the Community Based Infrastructure to Maximize Outreach and Consumer Assistance Indiana ACA Symposium March 15, 2013 Tricia Brooks

  2. Many Will Need Individualized Assistance • Becoming aware of new options and personal responsibility to have coverage • Determining if they qualify; how to apply • Overcoming language, cultural or accessibility barriers • Choosing an insurance plan • Understanding implications of premium tax credits and cost-sharing subsidies • Maneuvering different sources of coverage for different family members

  3. One Size Consumer AssistanceDoesn’t Fit All • Even people who prefer to apply online from home like knowing they can get help • Studies show mixed preferences for assistance in-person, online or over the phone • Diversity of assistance and assisters is key to meeting consumer needs • Experience shows that trusted, community-based organizations are essential

  4. Meeting the Needs of Consumers } • Needs (Demand) • Accessibility • Demographics • Resources (Supply) • Capacity and expertise of consumer assisters • Other factors impacting need for assistance • Communications & marketing • Technology ease of use • Eligibility & enrollment process • Coordination between agencies Consumer Needs

  5. Supporting Digital Age Consumer Self-Service • Consumer-tested, easy-to-use online applications with dynamic questioning • Pop-up help boxes; alerts • E-Chat • Personal accounts • Upload documents • Electronic notices • Co-browsing Supporting consumer self-service is as important a consumer assistance service as providing a human touch!

  6. navigators A Required Component of all Types of Exchanges: State-Based Federally-Facilitated Partnership

  7. Who can serve as navigators? Explicitly excluded from serving as navigators: At least one community or consumer-focused nonprofit, plus at least one of these entities: Chambers of commerce Licensed agents and brokers Trade/industry associations Commercial fishing, ranching and farming organizations Unions SBA resource partners Other public/private entities (i.e. tribal organizations or state/local government offices) • Health insurance issuers • Subsidiaries of issuers • Associations with members, or that lobbies on behalf of, the insurance industry • An entity or individual with a conflict of interest

  8. What eligibility criteria mustnavigators meet? • Be capable of carrying out the duties • Have relationships or can easily establish relationships with those likely to be eligible for enrollment in a QHP • Employers and employees • Consumers (including uninsured and underinsured) • Self-employed individuals • Meet licensing, certification or other standards prescribed by the state or Exchange • Have no conflicts of interests • Comply with privacy and security standards

  9. What are the required dutiesof navigators?

  10. How will the FFE select navigators? • HHS will award grants, train and manage • Federal funding opportunity announcement (expected soon) • Organizations can take early steps to be ready by registering – get a registration checklist here: http://grants.gov/assets/organizationregcheck_092112.pdf

  11. CERTIFIED APPLICATION COUNSELORS Proposed standards in latest 1/14/13 Notice of Proposed Rule Making released; subject to final rulemaking.

  12. Building on Existing Community-Based Application Assistance Infrastructures • Option in Medicaid; required in Exchange • Exchange must certify Medicaid CAC’s • Staff and volunteers assist with application, renewal, documentation requirements, ongoing case management • Regulations are intended to ensure: • Training, skills to provide reliable, effective assistance • Meet confidentiality and conflict of interest standards • CACs are authorized to have access to an individual’s tax related data

  13. State Requirements • Establish web-portal used only by certified application assisters (proposed for Medicaid only) • Establish procedures • Inform applicants and enrollees of CAC functions and responsibilities • Allows individuals to authorize CAC to assist; authorization is required before CAC are provided confidential information • Ensure that CACs do NOT charge for their assistance

  14. Our Panel: Jenny Sullivan Enroll America Sherry Gray St Vincent Health J Hopkins Wishard Hospital

  15. Georgetown Health Policy InstituteCenter for Children and Families • Tricia Brooks • Assistant Research Professor – Georgetown Health Policy Institute • Senior Fellow – Georgetown Center for Children and Families • pab62@georgetown.edu • 202-365-9148 • Our Website: http://ccf.georgetown.edu/ • Our child health policy blog: Say Ahhh!http://www.theccfblog.org/

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