A Person, Not An Application:Lessons Learned On a Health Insurance HelpLineKate Bicego, Health Care For All, Massachusetts

What is Health Care For All (HCFA)?

• Voice of consumers in Massachusetts health policy• National partner: Community Catalyst• Policy coalitions on health access, cost control, oral health,

children’s health,…• HelpLine ~ 30,000 calls/year, all staff trained CACs• www.hcfama.org, Twitter: @hcfa, Facebook: Health Care For All

HCFA Application Assistance Experience

• Enrollment via a free health insurance helpline

• Tens of thousands enrolled in subsidized health insurance (Medicaid & Marketplace) since 2006 health reform

• Over-the-phone enrollment, health plan education/selection, troubleshooting, follow-up

• Feedback loop to policymakers and state agencies (Medicaid and Marketplace)

Best Practices: Application Assistance Tips

•Tailor questions in the “language” person speaks and understands

•Ensure understanding and response is accurate

•Repeat answers

•#1 goal is to get folks covered & build an on-going relationship with the person/family

HCFA Application Assistance Experience: How to Conduct a Health Insurance Eligibility Screening

HCFA Application Assistance Experience: How to Conduct a Health Insurance Eligibility Screening

• Quick Medicaid & Marketplace “assessment” Step 2:

Determine household size:Determine household size:1. Are you single or married? 2. Do you have any children living in your house? How many?3. Do you have any tax dependents or are you claimed on anyone’s tax

return? Who?4. Are you or any member of your household pregnant? How many babies?

HCFA Application Assistance Experience: How to Conduct a Health Insurance Eligibility Screening

• Quick Medicaid & Marketplace “assessment” Step 3:

Determine household income:Determine household income:1. Are you or your spouse or other household member(s) currently working?

If yes, how many hours a week (usually) and how much do you earn per hour?

If no, do you or your spouse or other household member(s) get any income from anywhere like Social Security, alimony, or any other place?

2. Do you think your household’s income will be about the same when you file taxes next year or different? If different, how?

HCFA Application Assistance Experience: How to Conduct a Health Insurance Eligibility Screening

• Quick Medicaid & Marketplace “assessment” Step 4:Additional Medicaid Screening Questions*:Additional Medicaid Screening Questions*:

1. Are you or any household member disabled in any way, including a disabling mental health condition?

2. Are you or any household member HIV+ or have breast or cervical cancer?3. Did you ever get SSI?

*Your Medicaid screening questions will depend on Arizona Medicaid rules. The questions in this example are based on Massachusetts Medicaid special categories.

HCFA Application Assistance Experience: How to Make a Health Insurance Eligibility Assessment

• Quick Medicaid & Marketplace “assessment” Step 5:

Making the assessment*:Making the assessment*: Does the person meet the qualifications for Medicaid or to shop on the

marketplace? What is the household size? What is the household income? Does any member of the household have any “special” Medicaid category?

*Your assessment will depend on Arizona Medicaid rules and may differ from this assessment example.

Example: Medicaid & Marketplace Eligibility Screening

Example #1 household demographics: Example #1 household demographics:

All members of The Simpsons are U.S. Citizens and live in Springfield, AZ.All members of The Simpsons are U.S. Citizens and live in Springfield, AZ.Marge is unemployed and has no income. Marge is unemployed and has no income. Homer works at the local power plant, works 40 hours/week at $15.00/hour.Homer works at the local power plant, works 40 hours/week at $15.00/hour.No member of the household has a special Medicaid category.No member of the household has a special Medicaid category.

Example: Medicaid & Marketplace Eligibility Screening

Example #2 household demographics: Example #2 household demographics:

All members of The Simpsons are U.S. Citizens and live in Springfield, AZ.All members of The Simpsons are U.S. Citizens and live in Springfield, AZ.Marge is unemployed and has no income. Marge is unemployed and has no income. Homer works at the local power plant as a contractor (no insurance offer), Homer works at the local power plant as a contractor (no insurance offer), works 40 hours/week at $45.00/hour.works 40 hours/week at $45.00/hour.No member of the household has a special Medicaid category.No member of the household has a special Medicaid category.

Example: Medicaid & Marketplace Eligibility Screening

Example #1 & 2 questions for eligibility screening:Example #1 & 2 questions for eligibility screening:

Does the household potentially qualify for Medicaid or shopping on the Does the household potentially qualify for Medicaid or shopping on the Marketplace?Marketplace?What’s their household size?What’s their household size?What’s their income?What’s their income?Does any member of the household have a special Medicaid category?Does any member of the household have a special Medicaid category?

Example: Medicaid & Marketplace Eligibility Screening

Example #1 & 2 answers for eligibility screening:Example #1 & 2 answers for eligibility screening:

What health insurance program(s) do the Simpsons potentially qualify for in What health insurance program(s) do the Simpsons potentially qualify for in example #1? Why?example #1? Why?

What health insurance program(s) do the Simpsons potentially qualify for in What health insurance program(s) do the Simpsons potentially qualify for in example #2? Why?example #2? Why?

Income Limits for Help Paying for Health

Insurance

Household SizeMedicaid138% FPL

Help Paying for Qualified Health Plans From Marketplace

400% FPL

1 $15,288 $45,960

2 $20,640 $62,040

3 $25,980 $78,120

4 $31,332 $94,200

5 $36,672 $110,280

6 $42,024 $126,360

After the Application: Important Questions to Help Consumers Make Health Insurance Plan Decision

•What is most important to you in a health plan?o Cost? Provider network? Brand name?

•How will you use health plan? • Regular visits to a doctor? Prescriptions?

•Do you want a high or low premium/cost-sharing?

After Plan Selection: Other Lessons Learned

• Explain the importance of paying your “monthly bill/cost” on-time (premium)

• Encourage enrolled consumers to reach out to you for any help with health coverage (ex. household/life changes/renewals)

• Have other “public assistance” resources on-hand for referrals when needed

Application Assistance Reminders

•You don’t have to ask every question!

•Learn from your mistakes!

•Remember the difference you’re making!

Questions???