Enroll America will execute a national enrollment campaign using cutting-edge engagement strategies and will continue to build coalitions + share best practices
Health Insurance ExchangesA marketplace to purchase and enroll in health insuranceCan be State or federally run“No Wrong Door” entry point for all forms of coverageDetermine eligibility for different plans and subsidies.Seamless enrollment for all program (public and commercial). Provides consumers with easy way to review all optionsExchange certifies qualified health plans which must offer “essential health benefits”The Mental Health Parity and Addiction Equity Act appliesInsurance Affordability ProgramsPremium tax subsidies for moderate income non-Medicaid eligible population up to 400% FPLCost-sharing subsidies to eligible enrollees up to 250% FPLPremium tax credits are refundable and payable in advanceMedicaid ExpansionLow-income Americans can enroll in the program regardless of whether or not they have dependent children or a disabilityA uniform nationwide Medicaid eligibility floor of 138% of Federal Poverty Level (FPL) New Medicaid eligibility group for low-income individuals not otherwise eligible under an existing mandatory category in MedicaidEligibility will be based on income only – no asset or resource testModified Adjusted Gross Income (MAGI): Total income, interest income, and foreign earned income.
Children’s coverage remains the sameUp to 200% of povertyCoverage for pregnant women remains the sameUp to 200% of povertyExisting Medicaid coverage for adults remains the sameParents up to 90% of povertyOption to cover adults without dependent children in MedicaidUp to 138% of povertyExchange coverage Adults and children ineligible for other coverageTax credits to help with premiums between 138% and 400%
These are # of eligible, NOT likely the number likely to enrollThese figures will likely change with the September release of the new census figures1.5 million nonelderly uninsured% Medicaid% exchange% exchange w/out APTC790,000 <138% FPL611,100 Between 138-400% FPL126,400 400% FPL and upTake-up Rate in Children’s Medicaid in Ohio = %
Sources:Medicare low-income subsidy, 2009* - http://www.kff.org/medicare/upload/8094.pdfUnemployment benefits - http://aspe.hhs.gov/health/reports/2012/MedicaidTakeup/ib.shtml#_ftn21 Earned income tax creditSNAP (food stamps)Just because it’s accessible, doesn’t mean people will automatically apply. Other programs have taught us this. In places where enrollment in programs has increased, it has been combined with significant marketing and outreach. But where are they? Where do they live?Next slide
Consumers trust safety net providerswith their health care, so trusting them to provide assistance getting health coverage is a natural fit. In fact, research suggests that health care settings are one of the most popular places people would like to go for enrollment help.
Half of uninsured in only 115 counties (of 3,300+ counties nationwide)Franklin county = county w/39th highest number of uninsuredCuyahoga county = 42ndHamilton county = 83rd
17% of adults between 18-64 less then 400% FPL have a college degree30% of uninsured adults and 49% of the uninsured expansion population have less then a high school education76% are below 250 FPLEA LOOKS AT THESE NUMBERS TO IDENTIFY TARGET AUDIENCES. MORE THAN HALF OF THE UNINSURED WILL BE MEDICAID ELIGIBLE, AND LATINOS OVERWHELMING REPRESENTED¼ SPEAKS A LANGUAGE OTHER THAN ENGLISH IN THE HOMEWHAT ELSE DO THEY ALL HAVE IN COMMON?
FOR SOME THIS MAY BE OLD INFORMATION, FOR OTHERS THIS MAY BE TOO COMPLEX- REMEMBER THE END GOAL: HAVING SOMEONE AVAILABLE TO HELP PEOPLE APPLY.FOR THOSE THAT HAVE HAD SOME EXPERIENCE WITH MEDICAID IN THE PAST- IT’S BEEN COMPLEX AND FOR MANY, TRYING TO NAVIGATE THE SYSTEM HAS FELT LIKE THE PICTURE ON THE LEFT
NOT necessarily a single point of entry!The goal of no wrong door is to create a system where services wrap themselves around the individual and provides seamless access to all available optionsIt is philosophy that can support many different models for helping people get the information they need to get services and supports. Some states are applying the “no wrong door” policy through an integrated/centralized systems – significant cost-savings Others apply the “no wrong door” philosophy through an intricate information and referral system that creates a virtual door in multiple locations, the coordinated/decentralized approach. In this model, consumers have seamless, real-time access to relevant and necessary information about services, but the full array of services may not be offered in one location.In-person assistance: will return to later but that could be through navigators, OEWs, person to person assistance, etcCoordination Notes:Agencies must work together and exchange data electronicallyOnce information has been collected once, cannot be requested againExchanges must make Medicaid eligibility determinations for MAGI-populations; may refer non-MAGI determinations to Medicaid agencyIndividuals receiving a disability-related Medicaid determination can enroll in Medicaid/exchange while awaiting final determination
78% of the public doesn’t know about the changes in coverage that are coming83% of potentially Medicaid eligible populations don’t know changes are coming*BUT* when people are given more information about QHPs/health insurance exchanges/premium tax credits and the possible Medicaid expansion, they are interested. However, most expect they will need help figuring out this new system.This makes sense, because when we ask people about their experience trying to get affordable coverage in the past, most have very negative feelings associated with this experience. Having reliable, knowledgeable, accessible sources of enrollment assistance is one of the best ways to reverse these feelings and get people to a more confident, secure place when it comes to their feelings about coverage.
Often tempted to think that this population does not have access to the Internet; their access is more limited that the general population, and most limited for those with income <139% FPL, but our research found that they are nonetheless relatively “wired”.63% of uninsured adults say would be very (31%) or somewhat likely to go to the exchange website to find and compare plans if they did not have insurance in 2014.44% of the uninsured have made a website purchase in last 3 months.BUT, while electronic communications may be an important medium for outreach and peer-to-peer sharing of information about health coverage, our survey found that people prefer to get help in person.
Our findings bear this out; on average about a third said they would be uncomfortable using a website to find a plan, and almost half said getting health insurance is too important to do online. Especially true of Medicaid expansion population (to the extent we have data on them).40% of women in expansion population are uncomfortable using a website to find a plan.53% of uninsured women think getting health insurance is too important to do online.Going back to those initial feelings about purchasing coverage and past experiences, people perceive health coverage as complex, important, and at times anxiety-inducing; it’s not the same as other online purchases.
So, how *do* people want to get help?--important to keep in mind here that respondents were answering questions based on their current experiences of the world; don’t necessarily know about all the changes coming in 2014 with Navigators, IPAs, new application process, etc.—What kind: other things include where to go for help, fillingout the application, and how to use the websiteHow: in person is hands-down most preferred (even more so among uninsured than general population: 77% vs. 75%)From Whom: someone whose job it is = most important for uninsured, followed closely by other options; all should be able to refer, or should consider housing trained assisters (if not serving in that role themselves); also important to think about these individuals as outreach messengers = mom, partner/spouse are trusted messengersWhere: Universe for these data = uninsured, except for “Where?” that is among all survey respondents Which family member? Spouse (42%) or mom (20%)People also need information about how help is available, where they can go for help.Among the <139% FPL uninsured population, #1 preferred source of help is “state/fed govt. worker whose job it is to help” followed by family member or doctor/provider (tied), then lastly Medicaid office. As go up income scale, growing preference for help directly from health insurance company, but state/fed worker is still always #1.
Knowledge is most important factor in who is providing assistance – why we see agents/brokers and insurance companies as leaders among who respondents wanted to get assistance from.Despite long waits and sometimes cumbersome administrative process, people value seeing an enrollment worker who can work with them one-on-one. Know that their paperwork was submitted correctly and completely, know what to expect for next steps, know how to use their coverage.Will be important to include information about help being available and how to get that help in outreach and education messages.
STATES HAVE OUTSIDE BUBBLES CURRENLTY TO HELP PEOPLE GET COVERAGE (TO VARYING DEGREES)IN THE FUTURE- THE BUBBLES IN THE CENTERS WILL ALSO EXIST.OUTER BUBBLE= CACSCENTER= FOR STATEBASED AND PARTNERSHIP EXCHANGESNAVIGATORS ARE GRANTS AND IN EVERY STATE
A message with all four facts reaches 89% of the population and 87% of the uninsured population. This means for 89% of the population, the most important fact is one of the top four facts above. Common key findingsUniversal value of insurance Cost and affordability are biggest barriersUniversal messages surrounding exchanges Deep skepticism among consumersPrevious bad experienceToo good to be true Insurance is confusingLatinos vastly overrepresented among uninsuredEveryonewants help enrolling in coverageA message with all four facts reached 89% of the population and 87% of the uninsured population. This means for 89% of the population, the most important fact they need to hear is one of these four.NEW WAY TO BUY COVERAGE, HELP WITH THE COST WITH THEM. KNOWING THERE IS HELP WITH THE COST OF COVERAGE IS ESSENTIAL. KNOWING THAT THE COVERAGE THEY ARE GOING TO BUY IS ACTUALLY GOING TO GET THEM THE HELP THAT THEY NEED ARE THE THE TWO THINGS THAT GETS THEM TO FEELING SAFE SECURE.We are putting together in-depth looks at target populations such as the clusters mentioned and also by race and income. There are minor differences- for example: amongst Latinos- in california and florida- the top motivators are financial security, your plan will be there for you, and you will be able to find a plan that fits your budget. In Texas the motivators are the same but in a different order- financial security, you will be able to find a plan that fits your budget and your plan will be there for you.
What role will your hospital play?What is your hospital currently doing?What tools exist?What tools does your hospital need?
Exchange branding researchPublic opinion pollingStatewide marketing and outreach plans
The Role of Safety Net HealthCare Providers in Outreach and Enrollment (Enroll America)
1The Role of Safety Net Providers inOutreach & EnrollmentCommunity Connections Pre-Application WorkshopJenny Sullivan April 26, 2013
Delivering on the promise ofaffordable health coverage formillions of Americans . . .2
Enroll AmericaTwo-fold StrategyOur MissionMaximize the number of uninsured Americans whoenroll in health coverage made available by theAffordable Care ActPromoting Enrollment Best PracticesNational Enrollment Campaign Using CuttingEdge Engagement Strategies124
The 2014 Enrollment Opportunity051015Source: February 2013 CBO estimatesMillionsEnroll at least 15 million people in new coverage options} 7 million in Exchange coverage8 million in Medicaid or CHIP}5
Health Coverage in 20146MedicaidExchange(“Marketplace”) withTax CreditsExchange orPrivate PlanIncome as a percent of the federal poverty level0 133 400+Coverage Options for Adults without Medicareor Employer-Based CoverageAn Opportunity for a Complete Continuum of Coverage
The Coverage Continuum in OhioChildren PregnantWomenParents Non-parentadultsExchange without taxcreditsExchange with taxcreditsMedicaid expansion?Medicaid400%300%200%100%Percentageofthefederalpovertylevel??
The Enrollment Opportunity in OhioSource: March 2011 and 2012 Current Population Survey790,000611,100126,40002004006008001,0001,2001,4001,6001,800Non-elderly uninsuredThousandsLikely exchangeeligible, w/outfinancial helpLikely exchangeeligibile w/financialhelpLikely Medicaid-eligible8Connect more than 1.5 million people to coverage
Enrollment isn’t a snapProgramPercent of Eligible PeopleEnrolledChildren’s Medicaid/CHIP, national average, 2009 84.8%Medicare low-income subsidy, 2009* 40%Unemployment benefits 72-83%Earned income tax credit 80-86%SNAP (food stamps) 54-71%* Does not include populations automatically enrolled in the low-income subsidy.Take-up in optional public benefit programs
Limited Public AwarenessThe majority of uninsured Americansdon’t know the health reform law willhelp them.75%Three out of four of the newly eligiblewant in-person assistance to learnabout and enroll in coverage.10Enroll America Research, November 201278%
CATXFLNYGAILNCOHPANJMIAZVATNWAINMOSCLAMDALCORest of the USWhere aretheUninsured?11Two-thirds ofthe uninsured livein 13 states• California• Texas• Florida• New York• Georgia• Illinois• North Carolina• Ohio• Pennsylvania• New Jersey• Michigan• Arizona• Virginia
Demographic Profile of the Uninsured(Nonelderly Adults, Ages 18-64)1253%47%Race/EthnicityPercent ofUninsuredUninsuredRateWhite (non-Hispanic) 45% 13%Black (non-Hispanic) 15% 21%Hispanic 32% 32%Asian/Pacific Islander 5% 18%American Indian/Alaska Native 1% 27%Two or More Races 2% 15%62%Live in Familieswith at least OneFull Time Worker38%13%25%13%10%Federal Poverty LevelSource: Kaiser Commission on Medicaid and the Uninsured, October 2012
Why Safety NetProviders?13Relationships with the uninsuredCommunity BenefitDSH decreasingMedicaid Primary Care Rates IncreasingPartofCoreMission People trustprovidersEnroll theWhole Family
Requirements for ALL statesA Single, Streamlined Application• One application for all health coverage programs• Available in online, phone, and paperUse Modified Adjusted Gross Income/No Income DisregardsEliminate Asset TestsEliminate In-Person Interview RequirementsUse Electronic Verification to the Greatest Extent PossibleRegardlessof Medicaidexpansion!
A New Way to Enroll in CoverageConsumers can connect to whichever program they are eligiblefor, no matter where they start.16Complete singleapplicationDetermine eligibilityEnrolled in correctprogram!MedicaidCHIPIn-PersonAssistanceExchangeSingleApplication
Public Perceptions75%Three out of four of the newly eligiblewant in-person assistance to learn aboutand enroll in coverage.17Help gets themfrom here… …to here.Source: Enroll America, November 2012
Uninsured, but Online and Connected6357205767633962744938778171487573673168020406080100Frequentinternet userFacebookuserSmart phoneuserUses textmessagingUninsured <139% FPLUninsured LatinosUninsured AfricanAmericansUninsured Young AdultsUninsured Women18PercentSource: Enroll America, Forthcoming March 2013
Too Important to Do Online?29433049364931423553020406080100Uncomfortable using awebsite to find a planGetting health insurance istoo important to do onlineAll UninsuredUninsured LatinosLatinos <139% FPLAfrican Americans*Uninsured Women19PercentSource: Enroll America, Forthcoming March 2013*Data provided are for all African Americans; subset for uninsured AfricanAmericans not available.
Preferences for Help: The Uninsured207%24%30%77%Online ChatEmailTelephoneIn-person21%22%27%29%Medicaid officeClinic/doctors officeFamily/friends homeAgent/brokers officeWhat Kind?From Whom?How?Where?52%56%Finding the bestplanQualify forfinancial help?31%32%32%34%48%Health insurancecompanyMedicaid officeDoctor or nurseFamily memberState employee whosejob it is to helpSource: Enroll America, November 2012
Value of In Person Assistance21• What is and isn’t covered• Out of pocket costsKnowledge• In-person beats online/self-serviceexperienceSecurity• Have provided all necessarypaperwork• Have completed application correctlyConfidence• Know when their insurance will start• Know what to do if they need healthservices before they get their cardReassuranceSource: Enroll America, Forthcoming March 2013
Understanding State Assistance Options22CertifiedApplicationCounselorsIn-PersonAssistancePrograms*Navigators*IPA programs not available in federally facilitated exchange states.ConsumerAssistanceProgramsMedicaideligibilityworkersInsuranceAgents, BrokersOtherCommunityBasedGroups
But enrollment doesn’t startuntil October...23What should webe doing now?
All insurance plans will haveto cover doctorvisits, hospitalizations, maternity care, emergency roomcare, and prescriptions.You might be able to getfinancial help to pay for ahealth insurance plan.If you have a pre-existingcondition, insurance planscannot deny you coverage.All insurance plans will haveto show the costs and what iscovered in simple languagewith no fine print.Four Key Messages to Reach Most UninsuredOne of these =top messagefor 89% ofpopulation
An Action Plan for Safety Net Providers251. Invest in staff/identifypartners2. Make your data work foryou3. Develop a plan4. Utilize technology5. Hold on to what you’ve got6. Recognize everyone’s rolein outreach
Outreach and Enrollment Resources• In-Person AssistanceResource Center• Public EducationResource Center26