Premium Assistance September 20, 2018 Project Access NOW & - - PowerPoint PPT Presentation

Premium Assistance

September 20, 2018

Project Access NOW & Premium Assistance

• Project Access NOW
• Started in 2007
• Health based non-profit with multiple programs
• Ensuring access to care, services, and resources for those most in need
• Premium Assistance
• Financial assistance program
• Started in January 2014
• Project Access NOW and Oregon Health Leadership Council
• Funded by Hospital Systems Network
• Kaiser Permanente, Providence Health and Services, Adventist Health, Tuality

Healthcare, Legacy Health, OHSU

• Part of Outreach, Enrollment and Access program
• Serves low-income Portland Metro tri-county residents

Program Benefits

• Monthly premium payment
• Reduced out-of-pocket costs*
• Pharmacy co-pay assistance
• Navigation of health care and Marketplace

Eligibility Requirements

• Under 300% FPL
• Resident of Clackamas, Multnomah, or Washington County
• Enrolled in Qualified Health Plan (QHP) through Marketplace
• Silver-level with Kaiser, Moda, PacificSource, or Providence
• Eligible for tax credit
• Not eligible for other “affordable” qualified health insurance
• Use full tax credit

Pros and Cons

• Not an overhaul of the current system
• Filling in the cracks
• Helps clients who would otherwise not have access to affordable coverage
• Does not address systemic barriers
• Eliminates some, but not all, barriers to using coverage
• State-based Marketplace

Capitalizing on Existing Resources

• Tax credits (APTCs) and cost-sharing reductions (CSRs)
• Hospital Charity Care & Community Benefit
• Hospital Systems Network funding
• Bill write-offs
• Relationships with insurance carriers
• Referrals from community partners

Current Challenges

• Relationships with insurance carriers
• Processes for third-party payments
• Single contact at insurance carrier billing offices
• Helping clients understand and utilize their insurance and PA
• Providers’ differing policies
• Client navigation and follow up
• Rate changes
• Changes in eligibility and transitioning clients
• Ineligible populations
• Tax credit reconciliation

Potential Challenges

• Funding
• Hospital and provider policies
• Processes for third-party payments
• Enrollment assisters and outreach in local areas
• Client navigation and follow up
• Establishing relationships with insurance carriers and providers
• Plan availability in rural areas
• Barriers to care
• High-risk clients

Similar Programs

• COFA Premium Assistance
• Health Insurance Premium Program - American Kidney Fund
• Ryan White HIV/AIDS Program