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A coordinated statewide initiative to help uninsured Tennesseans enroll in new health care coverage options. Get Covered Tennessee. Beth Uselton Program Officer Baptist Healing Trust. Lisa Pote Senior Vice President Seedco of the Midsouth. Background. - PowerPoint PPT Presentation
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Get Covered TennesseeA coordinated statewide initiative to help
uninsured Tennesseans enroll in new health care coverage options
Beth UseltonProgram Officer
Baptist Healing Trust
Lisa PoteSenior Vice President
Seedco of the Midsouth
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
Name Organization PositionNancy Anness, APN St. Thomas Health
Vice-President of Advocacy, Access and Community Outreach
Ashley Arnold Insurors of Tennessee General Counsel & Chief Operations Officer
Pete Bird Frist Foundation Chief Executive Officer & President
Denise Bollheimer Bollheimer ConsultingCEO (Founder & former Chair, Healthy Memphis Common Table)
Rae Bond Chattanooga Medical Society and Project Access Executive Director
Dr. Brian Bonnyman, MD Cherokee Health Systems Family Physician
Dr. Teresa Cutts, PhDCenter of Excellence in Faith & Health, Methodist Le Bonheur
Director of Research & Innovation; (Congregational Health Network)
Brian Haile, JD Jackson Hewitt
Senior VP for Health Policy (Former Director of the Health Insurance Exchange Planning Initiative for the State of TN)
Tavarski Hughes Blue Cross Blue Shield of TN Public Policy Liaison
Dr. Carole Myers, PhD, RN University of Tennessee College of Nursing
Associate Professor (Former Co-Director of UT Center for Health Policy & Services Research)
Elliott Moore Mountain States Health Alliance; Project AccessDirector of Community & Government Relations
Dr. Ken Robinson, MD Shelby County Mayor's OfficePublic Health Policy Advisor (Former Commissioner of Health for State of TN)
Dr. Cathy Self, PhD Baptist Healing Trust Chief Executive Officer & President
Maitane Tidwell Inclusive Communications President
Carol Westlake Tennessee Disability Coalition; Executive Director (also Chair of Middle TN Safety Net Consortium)
Pam Wright, JD West Tennessee Legal Services Attorney, Elder Law Specialist
Dr. Jan Young, PhD, NP Assisi Foundation of Memphis Executive Director
Advisory Council
• 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
Where are we today?
Over 900,000 uninsured Tennesseans will be eligible for health insurance under the
Patient Protection and Affordable Care Act*
January 1, 2014
The “Tennessee plan”Private insuranceCost-sharing for
certain visitsNo wrap-around
servicesCommercial
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:1. Approval from Center for Medicaid &
Medicare Services (CMS)2. Votes from Tennessee General
Assembly to appropriate funding
FPL
400%
300%
200%
100%
Children Undocumented Immigrants
Adults w/o Children
People with Disabilities
ParentsPregnant Women
0% 0%
■ TennCare & CoverKids Marketplace (Exchange)
■ Uninsured
Tennessee Plan
Subsidized
Unsubsidized
Linking Uninsured Tennesseans to Coverage
400,000
525,000
Remain uninsured if
no deal
138%
Who is eligible for help?
Federal Poverty Level*
AnnualHousehold income
Medicaid (TennCare)
Health Insurance Marketplace
Premium Tax Credits
Cost-sharing subsidies
Single Family of four
To apply directly to private plan monthly
premiums
Offset out-of-pocket costs
like deductibles & copays
< 100% ? - -
≥ 100% $11,490 $31,322 X X X
100-250% X X X
≥ 250% $28,725 $58,875 X X X
250-400% X X
≥ 400% $45,960 $94,200 X* 2013 Poverty Levels
Case Study #1
The Jones• Married, no children• Own a small business• Purchase their own health
insurance• Annual combined income
= $60,000
Poverty Level: 382%Coverage Option(s): MarketplaceMaximum annual premium =
$6,036 / year(9.5% of income)
Subsidies: Premium Tax Credit = $336 No cost-sharing subsidiesMaximum out of pocket = $5,700
Case Study #2
The Gonzalez Family• Family of four• Both parents work full-time• No insurance offered at
work• Annual combined income
= $50,000
Poverty Level: 209%Coverage Option: MarketplaceRegular annual premium =
$9,869Maximum annual premium
they will pay = $3,314(6.63% of income)
Subsidies: Premium Tax Credit = $6,555 + Cost-sharing Subsidies
Case Study #3
The Reynolds
• Couple, no children• Jean works full-time for
minimum wage:$7.25 / hour
$15,080 / year• No health insurance
offered at work
Poverty Level: 96%Coverage Option:
Marketplace, full price
Annual premium = $6,036
(40% of income)No TennCare, No Subsidies
Who is left uncovered?1. Undocumented immigrants
• Estimated 120,000 to 140,000 undocumented immigrants living in TN1
2. 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
3. Those who neglect or refuse to enrollSources:1) "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>.2) University of Memphis; BCBST; American Journal of Managed Care; Division of Healthcare Finance and Administration.
Small Businesses
Individuals & Families
SSA
Qualified Health Plans
Federal Health
Insurance Marketplace
How will people enroll?
IRS INS
To verify income, social security benefits and citizenship status
and determine tax creditSmall Business
Group Health Plans
No wrong door
14
Single, streamlined application
Step 1: Tell us about yourself
Step 2: Current job and income information
Step 3: Your health coverage
Step 4: Sign & submit
21 page application reduced to 3 pages
Forms available online:http://www.cms.gov/CCIIO/Resources/Forms-Reports-and-OtherResources/ Downloads/AttachmentC_042913.pdf
Easy Shopping Experience
• Easy-to-read format• Glossary of terms
(deductible, co-pay, etc)
• Costs & benefits in plain English on two sheets of paper
The ChallengeThe majority of uninsured Americans don’t know
the health reform law will help them.
75% of the newly eligible want in-personassistance to learn about and enroll in coverage.
Source: Enroll America Research, November 2012
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
How will they know?Where will they turn for help?
Consumer Assistance
Public Education & Community
Outreach
Who are the uninsured in Shelby County?
142,645uninsured 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.
Who are the uninsured in Shelby County?
138% or Less 139-400% Above 400%0
10,00020,00030,00040,00050,00060,00070,00080,00090,000
100,00087,251
45,512
9,883
Relation to FPL, Shelby County
Percent of Federal Poverty Level
Num
ber o
f Res
iden
ts
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.
Who are the uninsured in Shelby County?
Under 18 19-25 26-34 35-54 55-640
10,000
20,000
30,000
40,000
50,000
60,000
15,886
25,236
33,826
54,041
13,659
Breakdown by Age, Shelby County
Age
Num
ber o
f Res
iden
ts
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.
Who are the uninsured in Shelby County?
81,516
57%
61,129
43%
Breakdown by Gender, Shelby Co.
Men Women
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.
Who are the uninsured in Shelby County?
88,84063%
36,135 26%
13,526 9%2,3022%
Breakdown by Ethnicity, Shelby Co.
African Amer-ican
White
Latino
Multi-Cultural
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.
Who are the uninsured in Shelby County?
97,027have 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.
And we only have 97 days
until October 1, 2013
SeedCo of the MidSouth, based in MemphisWho 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.
Lead Agency
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
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
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
Middle Tennessee 318,484 Uninsured
6 Navigators
West Tennessee227,278 Uninsured
6 Navigators
East Tennessee334,218 Uninsured
6.5 Navigators
What is a Navigator? Individual or entity that:
1) Conducts community outreach activities to identify uninsured individuals and small businesses
2) Raises public awareness about new marketplace options
3) 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
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
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.”
Training StandardsNavigators & CACs must be trained in:
Qualified Health Plan options in the Exchange
Affordability programsPremium tax creditsCost-sharing subsidies
Eligibility & benefits for TennCare & CoverKids
<30 hours
of online
training
Continuing Education
Required for Certification & Recertification
New consumer assistance in the Tennessee marketplace
Navigators Certified Application Counselors
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
Consumer Assistance
Agents & Brokers
NavigatorsCertified
Application Counselors
Carrier commissions for QHPs
No funding mechanism built in Federal grants
Private funding?
no commission for TennCare/CoverKids
Target Group? Employees Insurable and
Uninsurable Individuals
InsurableIndividuals
Where? Work Places Health Places Life Places
Examples of Locations
Less than 50 employees HospitalsFQHCs
Charity centersDoctor’s offices
Technical collegesTax prep centersLarge box stores
SchoolsNeighborhoods
CBOs
Who Will Enroll? Brokers Navigators CACs Navigators and CACs
Funded How?Commissions
Federal Funding
Private funds, other fundraising
Navigator funds and foundation funding
Navigator Planning/Foundational Assumptions:
500,000 people will get enrolled in a lot of different places.
What role can medical providers play in outreach
and enrollment?
1. 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
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
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.
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.
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:[email protected](901) 528-8341