Meeting The Enrollment Challenge

Beth UseltonProgram Officer

Statewide Meeting of Tennessee’s Charitable ClinicsMay 31, 2013

Over 900,000 uninsured Tennesseans will be eligible for health insurance under the Patient

Protection and Affordable Care Act*

January 1, 2014

How will they be covered?

Total 925,000

* IF Governor Haslam can get approval from CMS and the Tennessee General Assembly

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%

Subsidized

Unsubsidized

Linking Uninsured Tennesseans to Coverage

400,000

525,000

Remain uninsured if

no deal

138%

Who is eligible for help?

* 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: 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

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 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 3. Those who neglect or refuse to enroll

Sources: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.

Test drive the calculatorKaiser Family Foundation website:

www.kff.org/interactive/subsidy-calculator/

KFF offers many interactive tools, fact sheets, graphs & timelines

Small Businesses

Individuals & Families

SSASSA

Qualified Health Plans

Federal Health

Insurance Marketplace

How will people enroll?

IRSIRS INSINS

To verify income, social security benefits and citizenship status

and determine tax creditSmall Business

Group Health Plans

No wrong door

13

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

And we only have 122 days

until October 1, 2013

How will they know?Where will they turn for help?

Consumer Assistance

Public Education & Community

Outreach

Help, I Need Somebody!

Get Covered TennesseeA coordinated statewide initiative to help

uninsured Tennesseans enroll in new health care coverage options

Working together: We all play a role in a

successful enrollment effort!Insurers

Hospitals

Consumer groups

Retailers

Community Health Centers

Drug Companies

Civic Groups

Labor

Communities

of Color

Faith-based groups

Business

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

Name Organization Position

Nancy 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 Access Director 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 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

Where are we today?

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 Identified

•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.

Seedco’s Qualifications for the Navigator Program

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 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.”

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

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

Training Standards

Navigators & CACs must be trained in:

Qualified Health Plan options in the ExchangeAffordability programs

Premium tax creditsCost-sharing subsidies

Eligibility & benefits for TennCare & CoverKids

<30 hours of online

training

Continuing Education

Required for Certification & Recertification

Consumer Assistance Carrier commissions for QHPs

No funding mechanism built in Federal grants

Private funding?

no commission for TennCare/CoverKids

What role can clinics 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 clinics play in outreach and

enrollment?2. Identify staff to help as Certified

Application Counselors (CACs):– Social Workers– Intake / Front Office staff– Case Managers

Who is left uncovered?1. Undocumented immigrants

– Estimated 120,000 to 140,000 undocumented immigrants living in TN1

2. 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 3. Those who neglect or refuse to enroll

Sources: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.

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?

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

Timeline

42

Open Enrollment media blitz

events

Oct

ober

1, 2

013

Mar

ch 3

1, 2

014

Dec

Jan

Feb

Mar

Sep

Aug

Jul

June

MayAp

rSta

keholder Brie

fing

Naviga

tor/C

AC Tra

ining

s Sta

tewide

Naviga

tors

& CACs rec

ruite

d

Nav

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or P

ropo

sal D

eadl

ine

BHT launch

es project

Nov

Gov.

ann

ounc

es

no st

ate

exch

ange

Fede

ral F

OA

Rele

ased

Nav

igat

or A

war

ds

Advisory

Council Esta

blished

Develo

p Community

Partners

hips

Lead

agen

cy id

entified

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

Want to learn more?

ACA for Community Health Clinics Workshop:Monday, August 26th 1:30-3:30pm CSTCenter for Nonprofit Management

Beth UseltonProgram OfficerBaptist Healing TrustBeth.uselton@healingtrust.org(615) 284-8271 ext.12