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Meeting The Enrollment Challenge

Meeting The Enrollment Challenge. Statewide Meeting of Tennessee’s Charitable Clinics May 31, 2013. Beth Uselton Program Officer. Over 900,000 uninsured Tennesseans will be eligible for health insurance under the Patient Protection and Affordable Care Act*. January 1, 2014 .

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Meeting The Enrollment Challenge

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  1. Meeting The Enrollment Challenge Statewide Meeting of Tennessee’s Charitable Clinics May 31, 2013 Beth Uselton Program Officer

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

  3. How will they be covered? * IF Governor Haslam can get approval from CMS and the Tennessee General Assembly

  4. 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

  5. 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

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

  7. 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

  8. 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

  9. 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

  10. Who is left uncovered? • Undocumented immigrants • Estimated 120,000 to 140,000 undocumented immigrants living in TN1 • 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 • 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.

  11. Test drive the calculator Kaiser Family Foundation website: www.kff.org/interactive/subsidy-calculator/ KFF offers many interactive tools, fact sheets, graphs & timelines

  12. 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

  13. No wrong door

  14. 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

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

  16. 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

  17. And we only have 122 days until October 1, 2013

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

  19. Help, I Need Somebody!

  20. A coordinated statewide initiative to help uninsured Tennesseans enroll in new health care coverage options Get Covered Tennessee

  21. Business Retailers Labor Consumer groups Civic Groups Working together: We all play a role in a successful enrollment effort! Hospitals Insurers Community Health Centers Communities of Color Drug Companies Faith-based groups

  22. 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

  23. Advisory Council

  24. Where are we today? • 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

  25. Lead Agency Identified 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.

  26. Seedco’s Qualifications for the Navigator Program • 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.

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

  28. 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

  29. 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

  30. 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.”

  31. 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

  32. 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

  33. 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

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

  35. What role can clinics 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

  36. 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

  37. Who is left uncovered? • Undocumented immigrants • Estimated 120,000 to 140,000 undocumented immigrants living in TN1 • 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 • 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.

  38. 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?

  39. 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

  40. Timeline Navigator/CAC Trainings Statewide Develop Community Partnerships Lead agency identified Navigators & CACs recruited Advisory Council Established Stakeholder Briefing BHT launches project Open Enrollment media blitz events Jan Feb Apr Aug Sep Jul Mar June May Dec Nov March 31, 2014 October 1, 2013 Gov. announces no state exchange Federal FOA Released Navigator Proposal Deadline Navigator Awards 42

  41. 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: navigatortn@seedco.org (901) 528-8341

  42. Want to learn more? ACA for Community Health Clinics Workshop: Monday, August 26th 1:30-3:30pm CST Center for Nonprofit Management Beth Uselton Program Officer Baptist Healing Trust Beth.uselton@healingtrust.org (615) 284-8271 ext.12

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