Translating the Medicaid Expansion into Increased Coverage: The - - PowerPoint PPT Presentation
Translating the Medicaid Expansion into Increased Coverage: The Role of Application Assistance Webinar Tuesday, March 19, 2013 Agenda Overview Carole Stipelman Associate Professor of Pediatrics, University of Utah Donna Cohen Ross
The Role of Application Assistance
Webinar Tuesday, March 19, 2013
Associate Professor of Pediatrics, University of Utah
Senior Policy Advisor, Center for Medicaid and CHIP Services, Centers for Medicare and Medicaid Services
Director, Best Practices Institute, Enroll America
Managing Principal, Health Management Associates
Carole Stipelman Associate Professor of Pediatrics, University of Utah
children being served by a community health center
CATCH program
74% 0% 26% 76%
Enrolled Not Enrolled Because Application Not Submitted Pilot Clinic Control Clinic
SOURCE: Carole Stipelman, “AmeriCorps Members Increase Enrollment in Medicaid/CHIP and Preventive Care Utilization at a Community Health Center,” Journal of Health Care for the Poor and Underserved, under consideration.
Enrollment Experiences of Children in Pilot Clinic Providing Enrollment Assistance vs. Control Clinic Not Providing Assistance
2.8 0.7 0.5 1.2 0.4 0.2 0-12 Months 1-5 Years 6+ Years
Enrolled Not Enrolled
SOURCE: Carole Stipelman, “AmeriCorps Members Increase Enrollment in Medicaid/CHIP and Preventive Care Utilization at a Community Health Center,” Journal of Health Care for the Poor and Underserved, under consideration.
Well Child Visits During Six Months Following Eligibility Determination
Mean Number of Visits Per Child:
spread the model
through each step of the enrollment process
culturally and linguistically appropriate assistance
their clinics.
specialists after the grant funding ended.
providing enrollment assistance.
Most Clinics Found the Model to Be Financially Sustainable
assistance statewide and through additional channels
customizable cloud based program that provides reminders for application requirements, renewals dates, preventive care appointments, tracks enrollment outcomes
community-based organizations to provide assistance
Senior Policy Advisor, Center for Medicaid and CHIP Services, Centers for Medicare and Medicaid Services
Jennifer Sullivan Director, Best Practices Institute Enroll America
Three out of four of the newly eligible want in-person assistance to learn about and enroll in coverage.
Confused Overwhelmed Worried Helpless
Source: Enroll America, November 2012
63 57 20 57 67 63 39 62 74 49 38 77 81 71 48 75 73 67 31 68
20 40 60 80 100 Frequent internet user Facebook user Smart phone user Uses text messaging Uninsured <139% FPL Uninsured Latinos Uninsured African Americans Uninsured Young Adults Uninsured Women Percent Source: Enroll America, Forthcoming March 2013
29 43 30 49 36 49 31 42 35 53 20 40 60 80 100 Uncomfortable using a website to find a plan Getting health insurance is too important to do online All Uninsured Uninsured Latinos Latinos <139% FPL African Americans* Uninsured Women Percent Source: Enroll America, Forthcoming March 2013 *Data provided are for all African Americans; subset for uninsured African Americans not available.
7% 24% 30% 77% Online Chat Email Telephone In-person
21% 22% 27% 29% Medicaid office Clinic/doctor's office Family/friend's home Agent/broker's office
What Kind? From Whom? How? Where?
31% 32% 32% 34% 48% Health insurance company Medicaid office Doctor or nurse Family member State employee whose job it is to help
Source: Enroll America, November 2012
Qualify for financial help? 52% 56%
Finding the best plan
experience
paperwork
services before they get their card
Source: Enroll America, Forthcoming March 2013
Jennifer Edwards Managing Principal Health Management Associates
release their RFP to contract with navigators, in-person assistors, and/or certified application counselors.
be doing so by this summer to begin in October.
choose to build local capacity to assist with enrollment.
legislation which could create conflicts with federal navigator regulations.
– Number of assistors needed; scope of duties, coordination of duties among the assistance types – Recruitment and roles of existing enrollment assistance entities (e.g. CBOs, insurance brokers) – Funding of startup costs for new assistors, and financial incentives once established – Coordination between state and federal consumer assistance, and with federal or state marketing campaigns – Coordination for consumers across the income spectrum, with attention to stigma, churning, etc. – Licensure, certification, training and monitoring – Anticipation of federal guidance on many issues, including coordinating state and federal enrollment assistance
Medicaid or private insurance through the exchange
compensated by insurers
performance-based incentives for reaching 85% of monthly goals
including application and renewal assistance for all consumers (Medicaid and Exchange)
compensation from insurers
assistors