Transcript Diapositiva 1 - Church Health Center | Memphis, Tennessee

Get Covered Tennessee
A coordinated statewide initiative to help
uninsured Tennesseans enroll in new health care
coverage options
Beth Uselton
Program Officer
Baptist Healing Trust
Lisa Pote
Senior 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
• Baptist Healing Trust was tasked with:
•Recruiting an advisory council
•Convening potential community partners
•Conducting preliminary strategic planning
•Researching best practices
• 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
Advisory Council
Name
Organization
Position
Nancy Anness, APN
Ashley Arnold
Pete Bird
St. Thomas Health
Vice-President of Advocacy, Access and
Community Outreach
Insurors of Tennessee
General Counsel & Chief Operations Officer
Frist Foundation
Denise Bollheimer
Bollheimer Consulting
Chattanooga Medical Society and Project
Access
Chief Executive Officer & President
CEO (Founder & former Chair, Healthy
Memphis Common Table)
Rae Bond
Dr. Brian Bonnyman, MD
Dr. Teresa Cutts, PhD
Brian Haile, JD
Tavarski Hughes
Cherokee Health Systems
Center of Excellence in Faith & Health,
Methodist Le Bonheur
Jackson Hewitt
Blue Cross Blue Shield of TN
Executive Director
Family Physician
Director of Research & Innovation;
(Congregational Health Network)
Senior VP for Health Policy (Former Director
of the Health Insurance Exchange Planning
Initiative for the State of TN)
Dr. Carole Myers, PhD,
RN
University of Tennessee College of Nursing
Elliott Moore
Mountain States Health Alliance; Project Access
Dr. Ken Robinson, MD
Dr. Cathy Self, PhD
Maitane Tidwell
Shelby County Mayor's Office
Public Policy Liaison
Associate Professor (Former Co-Director of
UT Center for Health Policy & Services
Research)
Director of Community & Government
Relations
Public Health Policy Advisor (Former
Commissioner of Health for State of TN)
Baptist Healing Trust
Chief Executive Officer & President
Inclusive Communications
Carol Westlake
Pam Wright, JD
Dr. Jan Young, PhD, NP
Tennessee Disability Coalition;
President
Executive Director (also Chair of Middle TN
Safety Net Consortium)
West Tennessee Legal Services
Attorney, Elder Law Specialist
Assisi Foundation of Memphis
Executive Director
Where are we today?
•
•
•
•
•
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
January 1, 2014
Over 900,000 uninsured Tennesseans will be
eligible for health insurance under the Patient
Protection and Affordable Care Act*
The “Tennessee plan”
 Private insurance
 Cost-sharing for
certain visits
 No wrap-around
services
 Commercial
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
Linking Uninsured Tennesseans to
Coverage
FPL
Unsubsidized
400%
525,000
300%
Subsidized
200%
138%
100%
400,000
0%
Children
Pregnant Women
Parents
■ TennCare & CoverKids
 Marketplace (Exchange)
People with
Disabilities
Adults w/o
Children
■ Uninsured
 Tennessee Plan
Remain
uninsured if
0% no deal
Undocumented
Immigrants
Single
Family of
four
< 100%
≥ 100%
Health Insurance
Marketplace
Federal
Poverty
Level*
Annual
Household income
Medicaid (TennCare)
Who is eligible for help?
$11,490
$31,322
$28,725 $58,875
250-400%
≥ 400%
Cost-sharing
subsidies
To apply directly to
private plan monthly
premiums
Offset out-ofpocket costs
like deductibles
& copays
-
-
X
X
X
X
X
X
X
X
X
X
X
?
100-250%
≥ 250%
Premium Tax
Credits
$45,960 $94,200
* 2013 Poverty Levels
X
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): Marketplace
Maximum annual premium =
$6,036 / year
(9.5% of income)
Subsidies:
Premium Tax Credit = $336
No cost-sharing subsidies
Maximum 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 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 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.
How will people enroll?
Individuals
& Families
Federal Health
Insurance
Marketplace
IRS
Small
Businesses
SSA
Qualified Health Plans
INS
To verify income, social security
benefits and citizenship status
and determine tax credit
Small Business
Group Health Plans
No wrong door
14
Single, streamlined application
21 page application reduced to 3 pages
Step 1: Tell us about yourself
Step 2: Current job and income
information
Step 3: Your health coverage
Step 4: Sign & submit
Forms available online:
http://www.cms.gov/CCIIO/Resources/For
ms-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 Challenge
The majority of uninsured Americans don’t
know the health reform law will help them.
78%
83%
75%
of the uninsured don’t know about the
new health insurance exchanges
of people who could be eligible for the
new Medicaid expansion don’t know
about it
of the newly eligible want in-person
assistance to learn about and enroll in coverage.
Source: Enroll America Research, November 2012
How will they know?
Where will they turn for help?
Consumer
Assistance
Public
Education &
Community
Outreach
Who are the uninsured in
Shelby County?
142,645
uninsured 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?
Number of Residents
Relation to FPL, Shelby County
100,000
90,000
80,000
70,000
60,000
50,000
40,000
30,000
20,000
10,000
0
87,251
45,512
9,883
138% or Less
139-400%
Above 400%
Percent of Federal Poverty Level
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?
Breakdown by Age, Shelby County
Number of Residents
60,000
54,041
50,000
40,000
33,826
30,000
20,000
25,236
15,886
13,659
10,000
0
Under 18
19-25
26-34
Age
35-54
55-64
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?
Breakdown by Gender, Shelby Co.
61,129
81,516
43%
Men
Women
57%
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?
2,302
2%
Breakdown by Ethnicity, Shelby Co.
African
American
White
13,526
9%
Latino
36,135
26%
88,840
63%
MultiCultural
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?
97,027
have 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
Lead Agency
SeedCo of the MidSouth, based in Memphis
Who 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.
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
East Tennessee
334,218 Uninsured
6.5 Navigators
West Tennessee
227,278 Uninsured
6 Navigators
Middle Tennessee
318,484 Uninsured
6 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.”
<30
hours of
online
training
Continuing
Education
Required for
Certification &
Recertification
Training Standards
Navigators & CACs must
be trained in:
 Qualified Health Plan
options in the Exchange
 Affordability programs
Premium tax credits
Cost-sharing subsidies
 Eligibility & benefits for
TennCare & CoverKids
New consumer assistance in the
Tennessee marketplace
Navigators
 Community outreach
 Public education
 Distribute fair & impartial
information
 Facilitate enrollment
 Qualified health plans
 TennCare
 CoverKids
 Provide referrals for grievances
Certified
Application
Counselors
 Distribute fair & impartial
information
 Facilitate enrollment
 Qualified health plans
 TennCare
 CoverKids
 Provide referrals for grievances
Consumer Assistance
Carrier commissions
for QHPs
no commission for
TennCare/CoverKids
Agents &
Brokers
No funding
mechanism built in
Certified
Application
Counselors
Navigators
Private funding?
Federal grants
Navigator Planning/Foundational Assumptions:
500,000 people will get enrolled in a lot of
different places.
Target Group?
Employees
Insurable and
Uninsurable
Individuals
Where?
Work Places
Health Places
Life Places
Less than 50 employees
Hospitals
FQHCs
Charity centers
Doctor’s offices
Technical colleges
Tax prep centers
Large box stores
Schools
Neighborhoods
CBOs
Examples of
Locations
Who Will Enroll?
Funded How?
Insurable
Individuals
Brokers
Navigators
CACs
Navigators and CACs
Commissions
Federal
Funding
Private funds, other
fundraising
Navigator funds and
foundation funding
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/1741403/17
24393/?v=a
3. Contact Seedco:
[email protected]
(901) 528-8341