Outreach and Enrollment: The Path to New Opportunities in Coverage

1. Outreach and Enrollment: The Path to New Opportunities in Coverage 2013 Annual Conference & Clinical Summit, “Aiming for Excellence” - “Inreach, Outreach & Enrollment” Presenters: Sophie Stern and Dayanne Leal

2. SECTION 1 • Who we are • What we do • What is the enrollment opportunity

3. Enroll America Our Mission Maximize the number of uninsured Americans who enroll in health coverage made available by the Affordable Care Act Two-fold Strategy 1 Promoting Enrollment Best Practices National Enrollment Campaign Using Cutting Edge Engagement Strategies 2

4. Sampling of Our Partners

5. How the Campaign Fits In Enroll America will execute a national education and enrollment campaign 1. Educate and Engage 2. Mobilize to Enroll 3. Work with Partners to Ensure System works Successful implementation of ACA requires all-out effort by government, not-for-profits, insurers, hospitals, community health centers, health providers, and others

6. Campaign Strategies and Tactics

7. The 2014 Enrollment Opportunity Enroll at least 16 million people in new coverage options } 7 million in Exchange (“Marketplace”) coverage Millions } 9 million in Medicaid or CHIP Source: May 2013 CBO estimates Source: May 2013 CBO estimates

8. Pennsylvania's Enrollment Opportunity 1.24 million PA residents • <138% FPL in Medicaid or CHIP • 138%-400% FPL in Exchange (“Marketplace”) coverage • Source: Centers for Medicare and Medicaid Services (CMS) analysis of the 2011 American Community Survey (ACS)

9. SECTION 2 • Public Awareness of New Coverage • Research and Messaging • Eligibility, Benefits and Timeline

10. Public Awareness of the New Coverage? What percentage of uninsured people do you think know about the new coverage options coming this fall?

11. Increasing Awareness… …but many of the uninsured still don’t know *Source: Kaiser Family Foundation Source: Enroll America

12. Past Experiences Seeking Coverage have shopped for insurance outside their job 44% have been uninsured for 2 years or more 67% Source: Enroll America, November 2012

13. Key Findings Across Segments

14. Sample Premiums Seem Unaffordable… Reaction to a sample premium for a family of four, 250% FPL 12% …but focusing on yearly savings can help. 16% Percentage who found the same premium affordable when expressed in terms of annual savings compared to current premiums. 51% Source: Enroll America, November 2012

15. 4 Key Facts Reach Most Uninsured One of these = top message for 89% of population

16. New Coverage Options in 2014 States that Expand Medicaid 138% of poverty 400% of poverty Marketplace without Tax Credits >400% of poverty Medicaid 0-138% of poverty Marketplace with Tax Credits 139-400% of poverty States that Don’t Expand Medicaid 100% of poverty Medicaid cutoff 400% of poverty Marketplace without Tax Credits >400% of poverty Marketplace with Tax Credits 100-400% of poverty Medicaid* *Medicaid eligibility levels vary by state and population. Marketplace coverage without tax credits is available for individuals ineligible for Medicaid with income <100% of poverty.

17. Regardless of exchange type or Medicaid expansion! Requirements for ALL States

18. Marketplace Eligibility

19. Eligibility for the Marketplace

20. Eligibility for Tax Credits

21. Eligible for Cost Sharing Subsidies?

22. Essential Health Benefits • Ambulatory patient services • Emergency services • Hospitalization • Maternity and newborn care • Mental health and substance use disorder services, including behavioral health treatment • Prescription drugs • Rehabilitative and habilitative services and devices • Laboratory services • Preventive and wellness services and chronic disease management • Pediatric services, including oral and vision care

23. What is the timeline for getting health coverage? • Open enrollment starts October 1, 2013, coverage starts January 1, 2014 • Regardless of your income… there will be a plan for you! • Financial assistance available depending on income Marketplace Open Oct 1 to Mar 31 Sign up and select coverage Coverage starts Jan 1* *Must enroll by December 15th for coverage to start January 1st.

24. SECTION 3 • Enrollment process • Public Perception • Who will provide help

25. Enrollment isn’t a snap Take-up in optional public benefit programs * Does not include populations automatically enrolled in the low-income subsidy.

26. Single, Streamlined Application Complete single application Enrolled in correct program! Consumers can connect to whichever program they are eligible for, no matter where they start. Determine eligibility Exchange Medicaid In-Person Assistance CHIP Single Application

27. Public Perceptions Three out of four of the newly eligible want in-person assistance to learn about and enroll in coverage. Help gets them from here… …to here. Source: Enroll America, November 2012

28. Value of In Person Assistance Source: Enroll America, Forthcoming

29. Who Will Provide Help? Where do you fit in this mix? Consumer Assistance Programs Community Based Groups Insurance Agents, Brokers Medicaid eligibility workers Community Health Centers *In-Person Assistance Programs not available in federally facilitated exchange states.

30. Help, I Need Somebody! How? What Kind? From Whom? Where? Source: Enroll America, November 2012

31. Navigator Duties: Make Things EASIER

32. Certified Application Counselors • Integral part of ensuring adequate assistance, especially in states with fewer federal resources • Important role for CBOs, providers, hospital staff, health centers, etc. • Training provided by the exchange • Funding • No federal funding for CACs, but Medicaid administrative match available for Medicaid CACs (23 states fund now, but Nevada does not) • Flexibility for private funding • Must disclose conflicts, but fewer prohibitions than navigators, IPAs • Agree to “act in best interest of the applicant” • Must make info accessible to people with disabilities • No obligation to do outreach

33. New CAC Option for Organizations • Organizations may certify staff/volunteers to become CACs • Eligible organizations must: • (1) have processes in place to screen staff/vols to ensure that they protect personally identifiable information • (2) engage in services that position them to help those they serve with health coverage issues, and • (3) have experience providing social services to the community. • Orgs must enter into agreement with exchange and are responsible for their CACs following federal rules

34. Differences Between Assister Types

35. SECTION 4 • Who is the uninsured • What role do you play • Inreach, Outreach and Enrollment Best Practices

36. Five Clusters of Targets

37. Uninsured, Unnecessary & Uninterested • 71% uninsured, most >2 years • Only 22% consider health insurance necessary • Skeptical that they could find affordable coverage in 2014 • Good news: this group is moveable • Top motivators • Financial security • Finding a plan to fit budget • Individual mandate • Best messengers • Family • Friends • Doctor $$$

38. Reluctant but Reachable • 64% uninsured, most have tried to find coverage • Young, low-income, least educated, many have young children in Medicaid/CHIP • Majority (71%) consider health coverage necessary • “Soft” believers, can be moved when told more about new options • Best messengers • Doctor • Someone like them who has tried it • Someone from health agency • Top motivators • Reliable coverage • Financial security • Finding a plan to fit budget

39. Desperate & Believing • Best messengers • Medicaid office • Federal/state government official • Doctor • Poorest, sickest, least educated • 1/3 receive SNAP benefits • Strongest interest, least skepticism in new coverage options • Not aware of new options, but instantly interested when told • Top motivators • Financial security • Finding a plan that fits their budget • Mandate

40. Connected, Low-Income Women • Well-connected to Medicaid (themselves or their children) • Nearly half (48%) receive SNAP benefits • Many in fair/poor health, have chronic health conditions • Interested in new coverage options, but skeptical about costs • Best messengers • Someone like them who has tried it • Medicaid office • Federal/state government agency • Top motivators • Plan will be there for them when they need it • Financial security • Find a plan that fits their budget

41. Insured, but At Risk • Young, low-income (<250% FPL) • 63% covered now, but risk losing coverage: aging off parent’s plan, losing Medicaid, low-wage worker getting coverage through job • Weak interest in new options, very skeptical • Best messengers • Family member (mom, spouse) • Doctor • Someone like them who has tried it • Top motivators • Financial security • Plan will be there for them when they need it • Find a plan that fits their budget

42. Why Health Centers, Rural Health Clinics and other like-mission providers? Enroll the Whole Family Insured patients = better long term health outcomes People trust providers Part of Core Mission Relationships with the uninsured Medicaid Primary Care Rates Increase

43. Outreach and Enrollment Opportunities • What role will your organization play? • What is your organization currently doing? • What tools exist? • What tools does your organization need?

44. An Action Plan for Health Centers • Develop a plan • Invest in staff • Make your data work for you • Utilize technology • Hold on to what you’ve got • Recognize everyone’s role in outreach

45. Outreach Planning…

46. Outreach Best Practices

47. I. Identify Your Strengths

48. I. Identify Your Strengths (cont.)

49. II. Who is Your Target Audience? 62% Live in Families with at least One Full Time Worker 47% 53% Source: Kaiser Commission on Medicaid and the Uninsured, October 2012

50. Tips for Targeting