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Covered California Outreach, Education and Enrollment Program Presentation July 16, 2014 Elsa Ruiz-Duran Division Manager, Enrollment Assistance Program
Covered California Outreach, Education and Enrollment
Program Presentation
July 16, 2014
Elsa Ruiz-Duran
Division Manager, Enrollment Assistance Program
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The following presentation is not for consumer use and is for informational
purposes for the 2014 Stronger Bridges to Health Forum.
Consumer Assistance Efforts
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Role and Responsibility Funding Source Federal or State
Certified Educator: Work for a Covered California Outreach and Education Grant Recipient. Grant period: July 2013 – December 2014.
$43 million Outreach and Education Grant (Federal Grant)
No Federal or State Requirement.
Certified Enrollment Counselor: Work for an Enrollment Entity. Provide In-person enrollment assistance. $58 payment per application that results in effectuation of coverage; $25 renewal. $58 new Medi-Cal enrollment.
$21 million Consumer Assistance Initiative (Federal Grant). Medi-Cal payment from DHCS.
No Federal Requirement. State Regulation.
Navigator (Certified Enrollment Counselor): Work for a Covered California Navigator Grant Recipient. Conduct outreach, education, and enrollment assistance.
Self-sustainable budget. Federal Requirement. State Regulation.
Certified Application Counselor: Work for an Enrollment Entity. Provide enrollment assistance and must disclose their conflict of interest to the consumer in writing prior to enrollment assistance.
Covered California does not compensate for enrollment assistance work.
Federal Requirement. State Regulation pending.
What did we say we were going to do?
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1. Outreach and Education Grant Program:
o 2.6 M consumers eligible for subsidies through Covered California o Over 220,000 small business owners eligible for SHOP o Over 200,000 medical providers and allied staff
2. In-Person Assistance: o Partner: over 1,500 entities o Certify: 10,000 enrollment counselors by the end of 2014
3. Community Outreach Network: o Partner with 500 organizations: provide uncompensated outreach
and education support
What did we do?
1. Awarded: o ~$34 M grants to 50 organizations and over 250 subcontractors o $2.2 M grants to 3 small business focused organizations o $3.1 M grants to 4 medical professional organizations o 2,461 Certified Educators (as of May 9, 2014)
2. Recruited and certified:
o Over 800 Enrollment Entities o 5,776 Certified Enrollment Counselors (as of May 12, 2014) o 58% Spanish; 3% Cantonese; 3% Mandarin; 2% Vietnamese; 1%
Tagalog; 1% Korean Speaking.
3. Established: o Over 160 Community Outreach Network Partners
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RESULTS – CON PARTNERS IN SAN FRANCISCO
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*
Mayor Office of Edwin M. Lee
Lani Kent (415) 554.5262 [email protected]
Black Coalition on AIDS/Rafiki Wellness
Maxine Tatmon-Gilkerson, MPH, RD
(415) 615-9945 [email protected]
NICOS Chinese Health Coalition
Kent Woo (415) 788-6426 [email protected]
Myers Urbatsch, P.C. Kevin Urbatsch 415-896-1500 [email protected]
City College of San Francisco - Library
Lori Brown (415) 452-5585 [email protected]
SF Westside Volunteers Susan Pfeifer (415) 860.8081 [email protected]
Single Stop Shop Andrew Wu (415) 391-7170 [email protected]
BRIDGE Housing Gina Rivera (415) 225-5660 [email protected]
ENROLLMENT SUPPORT: CERTIFIED ENROLLMENT ENTITY PRODUCTION OCT. 1, 2013 – APRIL 15, 2014 338,897 individuals enrolled in Medi-Cal or Covered CA plans with Certified Enrollment Counselor assistance
o 229,223 (68%) Medi-Cal o 109,674 (32%) Covered California Plan
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Clinics 39%
CBOs 34%
Other 27%
Covered CA Enrollment by CEE Type
ENROLLMENT SUPPORT: CERTIFIED ENROLLMENT ENTITY PRODUCTION OCT. 1, 2013 – APRIL 15, 2014 Covered CA Plan Enrollment was concentrated among 150 of the 831 Certified Enrollment Entities: • Top 50 Entities = 50% (56,908 individuals)
• Top 100 Entities = 70% (77,495 individuals)
• Top 150 Entities = 80% (88,131 individuals)
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Lessons Learned – Best Practices • Education/workshop sessions
• Access
• Stories
• Multi-language, culturally relevant collateral materials
• Consumer follow-up is critical
• Focused outreach efforts
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What’s next? • Who is left to enroll?
• Why did some eligible consumers not effectuate or end
coverage?
Expand resources to an integrated Outreach, Education and Enrollment Navigator Grant Program. • $16.9M Competitive Request for Application
Grant issued
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What’s next? Extend Outreach and Education Grantees that do
not become Navigators through the end of 2nd Open Enrollment with no additional funding.
Continue In-Person Assistance Program through the end of 2nd Open Enrollment.
• $58 per application, $25 per renewal
• After 2015 Open Enrollment, convert to Certified Application Counselors (required federal uncompensated model)
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PROGRAM UPDATES: RECERTIFICATION TRAINING & EXAM
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RECERTIFICATION TRAINING FOR CECS
• Required
• Interactive Computer-Based Training (CBT) course
• Email notice when CBT available in the Learning Management System (LMS)
• ~ 3 hours
• Exam
• Starts in September 2014 – Due by November 2014
PROGRAM UPDATES: IDENTITY PROOFING IN CALHEERS
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IDENTITY PROOFING IN CALHEERS
CoveredCA.com enhanced process to verify applicant identity
• When: August 2014
• Where: Application process
• Who: Applicant or enrollment counselor
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IDENTITY PROOFING IN CALHEERS
Next Webinar: July 30, 2014 • CalHEERS’ Demonstration on Identity
Proofing • Paper Application Process
• Renewals
RESPONSES TO YOUR QUESTIONS FROM THE LAST WEBINAR
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RESPONSES TO YOUR QUESTIONS FROM THE LAST WEBINAR
Navigator Grant If you apply for the Navigator Grant program will you still be able to be a CEE?
Yes. CEEs that are also awarded a Navigator Grant will be compensated for Medi-Cal eligible applications through open enrollment as long as funding is available from DHCS. To receive compensation, CEES will need to submit applications under the CEE ID.
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Schedule Request for Applications Release June 30, 2014
Grant Applicant Webinar July 1, 2014
Letter of Intent to Respond Due July 8, 2014 Round 1 Response to Questions Posted on Exchange Website July 11, 2014
Round 2 Response to Questions Posted on Exchange Website July 17, 2014
Applications Due July 28, 2014
Evaluation and Selection Process July 29- August 26, 2014 Intent to Award Notice Posted on the Exchange's Website
Beginning August 27, 2014. May award in phases.
Last Day to Submit Protest Five (5) business days
Navigator Grant Award Period October 1, 2014- June 30, 2015
NAVIGATOR GRANT REQUEST FOR APPLICATIONS
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Certified Enrollment Entity (CEE) Payments To Date
CEE PAYMENT UPDATE
# CEEs Paid Total Paid
Covered CA Plans 527 $1,956,398 Medi-Cal 388 $1,129,144
Total Payments $3,085,542
NEXT SCHEDULED PAYMENTS
Covered CA August 1, 2014
Medi-Cal
COVERED CA TESTIMONIALS
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• Covered California is looking for individuals enrolled through the Exchange who are willing to publicly share their health coverage story.
COVERED CA TESTIMONIALS
RESOURCES
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The Health Consumer Alliance (HCA): • Partnership between Legal Aid organizations • Provides free local assistance to individuals and
families applying for or enrolled in Covered California or Medi-Cal.
CECs may refer consumers to HCA: www.healthconsumer.org OR (888) 804-3536.
HEALTH CONSUMER ALLIANCE
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Department of Health Care Services (DHCS) Medi-Cal Program:
• Learn about • How to apply • Locate a health care provider • File a complaint
PHONE: 1-800-541-5555 EMAIL: [email protected] WEBSITE: www.dhcs.ca.gov Listing of Local County Medi-Cal Offices: http://www.dhcs.ca.gov/services/medi-cal/Pages/CountyOffices.aspx
DHCS
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Special Enrollment: http://www.coveredca.com/faqs/special-enrollment/ https://www.coveredca.com/coverage-basics/special-enrollment/ https://www.coveredca.com/FAQs/cobra/ Navigator Program: http://hbex.coveredca.com/navigator-program/ Medi-Cal and pregnancy: https://www.coveredca.com/faqs/Medi-Cal/ http://www.dhcs.ca.gov/ Prescription drugs: http://www.coveredca.com/faqs/prescription-drugs/
COVEREDCA.COM RESOURCES
Q & A
Thank You
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