Transcript Diapositiva 1

Meeting The Enrollment
Challenge
Statewide Meeting of Tennessee’s Charitable Clinics
May 31, 2013
Beth Uselton
Program Officer
January 1, 2014
Over 900,000 uninsured Tennesseans will be
eligible for health insurance under the Patient
Protection and Affordable Care Act*
How will they be covered?
Federal
Poverty
Level
Over 400%
Coverage
Available in
2014
Marketplace
Number of
Tennesseans
eligible
50,000
100 – 400%
Marketplace
(with tax
credits)
475,000
0 – 100%
“Tennessee
Plan”
400,000*
Total
925,000
* IF Governor Haslam can get approval from CMS and the
Tennessee General Assembly
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 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 calculator
Kaiser Family
Foundation website:
www.kff.org/interactive/
subsidy-calculator/
KFF offers many
interactive tools, fact
sheets, graphs &
timelines
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
13
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
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!
What Kind?
• Figuring out if they qualify for financial help (55%)
• Finding the best plan for them (52%)
From Whom?
• Someone from your state whose job it is to help people with these new options (45%)
• Family member (37%), your doctor or nurse (36%), someone from a health
insurance company (35%)
• Which family member? Spouse (42%) or mom (20%)
How?
• In-person (75%), telephone (33%), email (20%), online chat (9%)
Where?
• Insurance agent or broker’s office (29%), family member or friend’s home (27%), clinic
or doctor’s office (22%), Medicaid office (21%).
Get Covered Tennessee
A 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!
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
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
Rae Bond
Dr. Brian Bonnyman, MD
Bollheimer Consulting
Chief Executive Officer & President
CEO (Founder & former Chair, Healthy Memphis
Common Table)
Chattanooga Medical Society and Project Access
Executive Director
Cherokee Health Systems
Center of Excellence in Faith & Health, Methodist
Le Bonheur
Brian Haile, JD
Tavarski Hughes
Dr. Carole Myers, PhD,
RN
Elliott Moore
Jackson Hewitt
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)
Blue Cross Blue Shield of TN
Public Policy Liaison
University of Tennessee College of Nursing
Associate Professor (Former Co-Director of UT
Center for Health Policy & Services Research)
Dr. Ken Robinson, MD
Dr. Cathy Self, PhD
Maitane Tidwell
Shelby County Mayor's Office
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
Dr. Teresa Cutts, PhD
Mountain States Health Alliance; Project Access
Where are we today?
• 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
Lead Agency Identified
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.
Seedco’s Qualifications for the Navigator Program
•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.
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 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
 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
<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
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
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
– Funders
- Advisory council
- Community partners
• Technical assistance
– Conduit of Information
– Policy Analysis
• Liaison to federal & state agencies
May
Apr
Mar
Feb
Jan
Dec
March 31, 2014
October 1, 2013
Navigator Awards
Sep
Aug
Jul
Navigator Proposal Deadline June
Federal FOA Released
Gov. announces
no state exchange
Nov
Timeline
Open Enrollment
media blitz
events
42
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:
[email protected]
(901) 528-8341
Want to learn more?
ACA for Community Health Clinics Workshop:
Monday, August 26th 1:30-3:30pm CST
Center for Nonprofit Management
Beth Uselton
Program Officer
Baptist Healing Trust
[email protected]
(615) 284-8271 ext.12