Tapping the Community Based Infrastructure to Maximize Outreach and Consumer Assistance

Indiana ACA Symposium

March 15, 2013

Tricia Brooks

Many Will Need Individualized Assistanceo Becoming aware of new options and

personal responsibility to have coverageo Determining if they qualify; how to applyo Overcoming language, cultural or

accessibility barrierso Choosing an insurance plano Understanding implications of premium

tax credits and cost-sharing subsidieso Maneuvering different sources of

coverage for different family members

One Size Consumer AssistanceDoesn’t Fit All

o Even people who prefer to apply online from home like knowing they can get help

o Studies show mixed preferences for assistance in-person, online or over the phone

o Diversity of assistance and assisters is key to meeting consumer needs

o Experience shows that trusted, community-based organizations are essential

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Meeting the Needs of Consumers• Needs (Demand)– Accessibility– Demographics

• Resources (Supply)– Capacity and expertise of

consumer assisters • Other factors impacting need

for assistance– Communications & marketing– Technology ease of use– Eligibility & enrollment process– Coordination between agencies

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Consumer Needs}

Supporting Digital Age Consumer Self-Service

o Consumer-tested, easy-to-use online applications with dynamic questioning

o Pop-up help boxes; alertso E-Chato Personal accountso Upload documentso Electronic noticeso Co-browsing

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Supporting consumer self-service is as important a consumer assistance

service as providing a human touch!

NAVIGATORSA Required Component of all Types of Exchanges:

State-Based

Federally-Facilitated

Partnership

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Who can serve as navigators?

Explicitly excluded from serving as navigators:

• Health insurance issuers• Subsidiaries of issuers• Associations with members, or

that lobbies on behalf of, the insurance industry

• An entity or individual with a conflict of interest

At least one community or consumer-focused nonprofit, plus at least one of these entities:

• Chambers of commerce• Licensed agents and brokers• Trade/industry associations• Commercial fishing, ranching and

farming organizations• Unions• SBA resource partners• Other public/private entities (i.e.

tribal organizations or state/local government offices)

What eligibility criteria mustnavigators meet?

o Be capable of carrying out the dutieso Have relationships or can easily establish

relationships with those likely to be eligible for enrollment in a QHPo Employers and employeeso Consumers (including uninsured and underinsured)o Self-employed individuals

o Meet licensing, certification or other standards prescribed by the state or Exchange

o Have no conflicts of interestso Comply with privacy and security standards

What are the required dutiesof navigators?

Navigators

Knowledge of all QHP options, as well as Medicaid, CHIP and BHP (if application)

Maintain Expertise

Conduct outreach and education ✔

Provide fair, impartial information on all QHP options ✔

Provide culturally and linguistically competent information, and in a manner that is accessible for people with disabilities ✔

Comply with privacy and security standards ✔

Have no conflicts of interest ✔

Refer consumers for grievances or appeals ✔

How will the FFE select navigators?

o HHS will award grants, train and manageo Federal funding opportunity announcement

(expected soon)o Organizations can take early steps to be ready

by registering – get a registration checklist here: http://grants.gov/assets/organizationregcheck_092112.pdf

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CERTIFIED APPLICATION COUNSELORS

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Proposed standards in latest 1/14/13 Notice of Proposed Rule Making released; subject to final rulemaking.

Building on Existing Community-Based Application Assistance Infrastructures

o Option in Medicaid; required in Exchangeo Exchange must certify Medicaid CAC’so Staff and volunteers assist with

application, renewal, documentation requirements, ongoing case management

o Regulations are intended to ensure:

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o Training, skills to provide reliable, effective assistanceo Meet confidentiality and conflict of interest standardso CACs are authorized to have access to an individual’s tax

related data

State Requirementso Establish web-portal used only by certified application

assisters (proposed for Medicaid only)o Establish procedures

o Inform applicants and enrollees of CAC functions and responsibilities

o Allows individuals to authorize CAC to assist; authorization is required before CAC are provided confidential information

o Ensure that CACs do NOT charge for their assistance

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Our Panel:

Jenny SullivanEnroll America

Sherry GraySt Vincent

Health

J HopkinsWishard Hospital

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Georgetown Health Policy InstituteCenter for Children and Families

o Tricia Brooks• Assistant Research Professor – Georgetown Health Policy Institute• Senior Fellow – Georgetown Center for Children and Families

• pab62@georgetown.edu• 202-365-9148

o Our Website: http://ccf.georgetown.edu/o Our child health policy blog: Say Ahhh!http

://www.theccfblog.org/