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In March, the Office of the Assistant Secretary for Planning and Evalua=on (ASPE) at the Department of Health and Human Services released an enrollment report summarizing the renewal ac=vity during the second open enrollment period in the health insurance marketplace. Of those nearly 9 million enrolled in states using the HealthCare.gov plaJorm, 53% were new enrollees, whereas 47% were covered for all or part of 2014 and were renewing their coverage. So it’s important to remember that more than half of consumers signed up now will be new to that renewal experience later this year. Within the marketplace, consumers can choose to ac=vely renew their coverage, or they can be auto-‐renewed in the same plan they had last year. Slightly more than half ac=vely renewed their coverage during the second open enrollment period for 2015 (with the rest geWng auto-‐renewed). To drill down further, a liYle more than half (56 percent) of those who ac=vely renewed switched plans with the rest ac=vely renewing into the same plan as they were enrolled in 2014. This exceeded ini=al expecta=ons, but there is always room to grow.
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To beYer understand consumer experiences with renewal, Enroll America conducted mul=ple surveys among those on our consumer email list of over 1.2 million subscribers during and a[er the close of the second open enrollment period. Roughly 83% of Enroll America consumers surveyed said they at a minimum compared their plan op=ons during the renewal process, which is good news. But for marketplace coverage, even with auto-‐renewal, and more vital for consumers with Medicaid and CHIP that may lose coverage otherwise, it’s so important for the enrollment community to maximize consumer engagement during the renewal process so that people stay covered in the best coverage that fits their needs. Recognizing that the Medicaid and CHIP programs and renewal process can vary from state to state, we’re pleased that experts from the Michigan Primary Care Associa=on, who have designed a successful outreach and enrollment program in their state, are willing to share strategies that other organiza=ons can consider implemen=ng in states and communi=es across the country.
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Medicaid/CHIP Data: Based on the 51 states (including the District of Columbia) that provided enrollment data for February 2015 reported over 70.5 million individuals were enrolled in Medicaid and CHIP. This enrollment count is point-‐in-‐=me (on the last day of the month) and includes all enrollees in the Medicaid and CHIP programs who are receiving a comprehensive benefit package. Marketplace: 14 State-‐based; 3 Federally-‐supported State-‐based; 7 Partnership; 27 Federally-‐facilitated
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Almost half of those without insurance at the start of Open Enrollment in 10/2013 had not had health insurance for over 5 years, or had never been insured.
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Once consumers are enrolled, staying covered isn’t guaranteed. Disenrollment occurs for several reasons: Some reasons are a natural part of life – Medicaid recipients can lose their eligibility through an increase in income or they can acquire other health insurance. They can also “drop out” or lose coverage (o[en uninten=onally) due to administra=ve barriers and lack of knowledge of the health coverage system Administra=ve process that require addi=onal documenta=on of income, immigra=on status, and other criteria affect people’s renewal. Cost can be a factor, or income changes that move people from Medicaid eligibility to eligibility for tax credits can cause people to go without insurance.
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Last year, consumers who did not take ac=on to update their income and receive new eligibility for APTC & CSR, maintained the same level of financial assistance from the previous year.
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States are all moving forward but not at the same pace. The Kaiser Family Founda=on brief “Modern Era Medicaid “ explained the differences among states sta=ng, “similar to enrollment processes, the ACA calls for new highly automated, paperless renewal processes for Medicaid and CHIP. When possible, states must use available data to renew coverage automa=cally (also called ex parte renewal). Many states are s=ll implemen=ng and transi=oning to these new processes, given a range of challenges including developing system capacity to process automated renewals, transferring data for exis=ng enrollees from old legacy systems to new systems, and crea=ng no=ces for individuals. In the interim, a number of states are relying on mi=ga=on strategies such as mailing forms to individuals to request the informa=on needed to complete renewal.” – Kaiser Modern Era Medicaid
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Knowing that we have a sizable group of people who will need guidance to navigate renewal successfully, and that renewal is not standard across health coverage programs and across states, what approaches should we take to prepare both enrollment assisters and consumers?
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Renewal Webinar details: � One-‐hour webinar and was recorded and archived online
� Provided screen shots of the online and paper renewal forms and prac=cal =ps from CACs
� AYendees-‐ state-‐wide human service organiza=ons and partners Michigan Renewal Challenges: • redetermina=on process is the same for MAGI and non-‐MAGI Medicaid Health
Coverage • the system is set up to screen for eligibility for all benefits, not just health
coverage • No=ces are difficult to understand and don’t come in a logical order • Very =ght turnaround for submiWng requested forms and proofs of income • Asset informa=on is required in online renewal
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Renewal & Re-‐enrollment Basics for 2015-‐ CCIIO Renewals, Reconcilia8on and Exemp8ons-‐ Center on Budget & Policy Priori=es Understanding Marketplace & Medicaid Renewal Approaches-‐ Georgetown Center for Children & Families and MPCA
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Consumers come to assisters with varying knowledge and awareness about health coverage and access to care. Our role as assisters is to fill gaps in knowledge. In many cases the only opportunity enrollment assisters have to educate is during the enrollment encounter; which is why it is important to include renewal educa=on at the =me of enrollment.
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One way MPCA CACs and our network of assisters brings renewal educa=on into the enrollment is through use of our enrollment worksheets. The worksheets outline the steps to successful enrollment in coverage and what consumers can expect a[er they get covered. Assisters use these worksheets to guide conversa=ons with consumers and offer them as a takeaway for the consumers records.
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At the end of the enrollment encounter, MPCA’s CACs use this Enrollment Quality Survey to ensure that their message has been understood.
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Assisters can pair MPCA’s Medicaid Renewal Guide with the enrollment worksheets. The guide includes important details and steps related to the renewal =meline and how to complete the renewal process.
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The website features: • Step by step guides for what happens a[er a coverage applica=on is submiYed • Resources for all coverage programs in one place (HMP, Marketplace, Medicaid, &
MIChild) • Downloadable worksheets for assisters to complete with clients with blanks to
write in client-‐specific informa=on • Key phone numbers and links • Informa=on about health plans including phone numbers, handbooks and provider
directories • Suppor=ve client educa=on on post-‐applica=on health behaviors • Informa=on about cost-‐sharing, retaining and renewing coverage • Links to resources for filing hearings, local advocates etc.
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MPCA includes renewal messaging in all educa=onal and outreach materials. These resources are editable and available to everyone in our OE Toolkit.
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The grant focused on three simple steps:
1. Ensure families understand how and when to reapply for coverage 2. Remind families to renew as their redetermina=on date(s) approaches 3. Offer assistance with redetermina=on for families over-‐the-‐phone and
at their Health Center Messaging was =med to compliment the Medicaid renewal =meline set out by the state. For example: The first message is sent during the 3rd week of the 11th month because we know the state produces redetermina=on leYers between the 10th & 17th day of the 11th month of coverage.
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Mobile phone ac=vity: Text-‐ 80% Internet-‐ 56% Email-‐ 50% Health-‐ 31%
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Ini$al text messages
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Par=cipants who choose to interact with the messages are connected to their Health center. Staff can find the client in our database, check their redetermina=on date and determine an appropriate course of ac=on to take records of these interac=ons are noted in the database. Those who have renewed their insurance successfully receive a follow up sa=sfac=on survey with a self addressed and stamped envelope to return it to us. Those who did not renew receive a follow up leYer to re-‐enroll as a “last ditch” effort.
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