The Health Insurance Counseling and Advocacy Program

Tatiana Fassieux, HICAP Program Manager Butte, Colusa, Glenn, Plumas and Tehama

CountiesAnne Kasper, HICAP Program Manager

Riverside, San Bernardino, Inyo and Mono Counties Margaret Reilly, HICAP Program Manager

El Dorado, Placer, Nevada, Sacramento, San Joaquin, Sierra, Sutter, Yolo and Yuba Counties Dori Silveria, HICAP Program Manager Kings and Tulare Counties

What is it?

Why is it?

Where is it needed?

Can we get there from here???

Background

LIS Program is designed to help Low-income beneficiaries.

Full or partial subsidies of premiums and Reductions in cost-sharing for the Medicare

prescription drug plans

Amounts in cost-sharing vary based on the income level and assets of the beneficiary.

Certain groups of low-income Medicare beneficiaries automatically qualify (are “deemed eligible”) for the LIS program.

• Full-benefit dual eligible individuals

• Medicare beneficiaries who are recipients of Supplemental Security Income benefits

• Participants in the Medicare Savings Programs (MSP)

QMB - Qualified Medicare Beneficiaries,SLMB -Specified Low-Income Medicare

Beneficiaries, QI - Qualifying Individuals

What about beneficiaries with low incomes and limited resources who do not fall into one of the automatic subsidy eligibility groups?

That would be the targeted population CMS is trying to enroll …

… with our help!

Congress asked that “…the Secretary (of Health & Human Services) Leavitt shall report on best practices in the successful enrollment of low-income beneficiaries” into the Medicare prescription drug benefit program (Part D).

Which particular activities (outreach, partnerships, involvement of key organizations, or others) and at what level (federal, state, local) contribute to effectively enrolling and transitioning … low income beneficiaries into Part D and the Low-Income Subsidy (LIS) program.

Now that is a good question …

What’s in a name?

Extra Help?Limited Income Subsidy?Extra Financial Help?

There is a reluctance to identify with the Low Income label.

Would a rose by any other name still smell as sweet?

How does LIS work?1. Beneficiaries eligible for the full subsidy received

100% premium subsidy.

2. For beneficiaries eligible for the partial subsidy, the law sets the sliding scale premium percentage (100%-25%)

3. Cost sharing refers to the beneficiary’s expenses (deductible and copayment or coinsurance) in the Part D plan, with the exception of the premium.

Beneficiaries eligible for the full premium subsidy have no deductible or copayment amounts.

How does LIS work?1. For beneficiaries eligible for the partial subsidy:

Deductible in 2009 is $60; Coinsurance is 15%.

2. Copayment is a fixed dollar amount ($2.40 for generic or preferred multiple source; $6.00 for other drugs in 2009)

3. Coinsurance is a percentage.

Success Factors a k a

Challenges and Opportunities

Identify – and then locate - the target population

Create appropriate messages

Collaborate with CBOs and FBOs

Facilitate Enrollment in LIS

From the Inland Empire: Target areas for outreach indicated as high on the zip code list for

residents who are potentially eligible, but who haven’t yet applied.

Target churches, organizations serving low-income clients (like public health clinics, nutrition sites, home-delivered meal programs, food banks).

Do not discriminate – make it a habit for counselors and outreach personnel to mention that extra help is available through Social Security if you fit into the guidelines.

 Consider hiring volunteer counselor to follow up by phone with people given LIS info and an application during a counseling session. 

After 6 to 8 weeks they would be contacted again to determine if they had gotten a reply about their eligibility.

From the Capitol Region …Dedicated LIS On-Line Assistance 9-County Outreach Effort

began July 2008limited success

New Counseling Session protocol: •Always ask income questions •Make appropriate notations on Intake Form•Follow-up with either

•Immediate on-line assistance, •LIS packet, or•Referral to central office for follow-up

LIS mentioned in every Community Presentation

The University setting in combination with vast rural areas: Beating the Bushes Campaign

Phase 1: Design Have dedicated counselor for outreach and counseling Prepare unique flyers to target clients in non-

traditional locations: Laundromats, grocery stores, car washes, banks, homeless shelters, bars, beauty shops, etc.

Identify partners Design data collection tools

Different color intake Ask how client heard of us – specifically, what outreach

medium they say or heard

Phase 2: OutreachMail outreach materials to partnersProduce TV commercial to run during

programs viewed by potential candidates

 Phase 3: Data Collection

Using existing reporting methodologies, track counselor and counseling time, number of intakes and outreach events accomplished with LIS/MSP funding.

Evaluate results for future projects.

Tools from TulareOperating under the auspices of Tulare

County Health and Human ServicesAffiliation opens doors

Rural Service Area Health Fairs are important Churches Food Banks Mobile Home Parks

With surprising frequency, often this emphatic comment is heard:“I’m not interested.”

COLLABORATION IS KEY Rely on Community-Based and Faith-Based Organizations toImplement Best Practices.

CBOs and FBOs can:

Identify beneficiaries through Public Benefit Program lists.

Identify and educate beneficiaries by reaching them during their daily activities.

Provide insight into strategies most likely to work locally.

Effectively tailor messages to their local communities.

Time Community Outreach to coincide with activities already planned for specific beneficiary populations.

The future is now …The on-line LIS application (developed by SSA), Medicare Prescription Drug Plan Finder (developed by

CMS), BenefitsCheckUp (developed by NCOA)

The use of on-line application and plan-finder tools is impossible without a technological infrastructure, such as computers, Internet access, and printers.

Technology investments are not one-time purchases but required regular funding to update and maintain.

A chicken in every pot

Our Goals:Build collaborative partnerships that engage

our mutual constituency

Create a message to which our target audience can relate

Enroll every eligible beneficiary, in every HICAP region, in the LIS program.

The sweet smell of success …

Can be found only with adequate planning and collaboration