Expansion Exchange Outreach Enrollment Strategies


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  • Patient navigator piece – required for the exchange; CHC outreach and enrollment workers seem to be a natural fit but navigator role is undefined. The Exchange Corporation is determining the criteria now for what defines a patient navigator. FQHCs are monitoring to ensure eligibility workers fulfill that role. The exchange could potentially replace existing programs that are happening, so really just try to figure out how they can figure it out, get training on how exchanges get set up and how to navigate that portal. Oregon Primary Care Association is weighing in on the essential benefits package required by exchange; Workgroup established (enabling services, payments, continuity of care, pcmh, etc) to make sure FQHC model is protected in the exchange
  • Expansion Exchange Outreach Enrollment Strategies

    1. 1. Medicaid Expansion & Health Insurance Exchanges Strategies for Successful Outreach & Enrollment Michigan Primary Care Association August 29, 2012 1
    2. 2. Agenda• Update on Michigan & Medicaid expansion - Doug• Update on Michigan & health insurance exchange - Doug• Discuss impact on Health Centers - Harry• Discuss outreach and enrollment strategies utilized in other states - Harry• Discuss what opportunities Michigan health centers have to grab populations impacted by ACA – Harry/Natasha 2
    3. 3. Doug Paterson  M.P.A.Director of State PolicyMichigan Primary Care Association Michigan Primary Care Association Webinar August 29, 2012 3
    4. 4. Affordable Care ActExpansion of Community Health Centers • $11 billion up-front investment thru Trust Fund Medicaid Expansion • Tax Subsidies making health insurance affordable for low and moderate income families and employers 4
    5. 5. Supreme Court Decision• Upheld constitutionality of individual mandate• Upheld insurance reforms • Prohibits denial based on conditions • Lifetime caps • Kids to 26 • New coverage standards • Establishes Exchanges• Medicaid expansion is unconstitutional coercion 5
    6. 6. Medicaid ExpansionPotential to reach 1.9 million more HealthCenter PatientsTen states have indicated they will notexpand: Florida Iowa Louisiana Mississippi Missouri Nevada New Jersey New York South Carolina Texas 6
    7. 7. Insurance ExchangesPurpose ◦ To provide individuals and small business employees with access to health insurance coverage beginning January 2014. ◦ Creates competitive marketplaces for direct comparison based on price, quality and options.  Facilitates the purchase of Qualified Health Plans by individuals  Establishes a Small Business Health Options Program (SHOP) 7
    8. 8. Types of Exchanges• State based exchange • State operates all activities • Governance • Consumer and Stakeholder Engagement and Support • Eligibility and Enrollment • Plan Management • Risk Adjustment and Reinsurance • SHOP operation • Organization and Human Resources • Finance and Accounting • Technology • Privacy and Security • Oversight, Monitoring and Reporting • Contracting 8
    9. 9. Types of Exchanges• State Partnership Exchange • State operates • Plan Management • Consumer Assistance • Both• Federally-facilitated Exchange • HHS operates all components but state MAY elect to use federal services for Medicaid and CHIP eligibility assessment or determination 9
    10. 10. Harry Perlstadt, PhD, MPHMedical Sociologist and Professor EmeritusMichigan State University Michigan Primary Care Association Webinar August 29, 2012 H Perlstadt <perlstad@msu.edu> 10
    11. 11. Passing the Affordable Care Act: Medicaid Expansion and Community Health CentersSpecial Deals to get the 60 votes in US Senate ◦ Sen. Ben Nelson (D-NB)  Feds to pay 100% of Nebraskas costs for expanding Medicaid indefinitely; ◦ Sen. Bernard Sanders (I-VT)  Extra funds to Vermont for Medicaid expansion  plus $10 billion for Community Health Centers nationwide. H Perlstadt <perlstad@msu.edu> 11
    12. 12. Medicaid ExpansionAffordable Care Act (ACA) expands Medicaid to nearly all individuals under age 65 with incomes up to 133-138 percent of the federal poverty line (FPL) which will extend coverage to large numbers of the nation’s uninsured population, especially adults.However, the ultimate reach of the program will depend heavily on both federal and state actions to implement the new law. Kaiser Commission Medicaid and the Uninsured H Perlstadt <perlstad@msu.edu> 12
    13. 13. Medicaid ExpansionThe federal government will pay a very high share of new Medicaid costs in all states Increases in state spending are small compared to increases in coverage and federal revenues and relative to what states would have spent if reform had not been enacted. Kaiser Commission Medicaid and the Uninsured H Perlstadt <perlstad@msu.edu> 13
    14. 14. Standard Lower Participation ScenarioAssumes moderate levels of participation similar to current experience among those made newly eligible for coverage and little additional participation among those currently eligible.Assumes 57 percent participation among the newly eligible uninsured and lower participation across other coverage groups. Kaiser Commission Medicaid and the Uninsured H Perlstadt <perlstad@msu.edu> 14
    15. 15. Higher Participation Outreach ScenarioAssumes more robust participation among those newly eligible (75 percent participation among the newly eligible that are currently uninsured and lower participation across other coverage groups)Assumes higher participation among those currently eligible for coverage than in the standard scenario. Kaiser Commission Medicaid and the Uninsured H Perlstadt <perlstad@msu.edu> 15
    16. 16. Medicaid Expansion: Michigan Medicaid Expansion to 133% of FPL, Impact of Reform on Uninsured Populations: Increase in Enrollment in 2019 Relative to Baseline T New Previously % Baseline % Change Enrollees Uninsured Decrease Medicaid in Newly Uninsured Enrollment Enrollment Enrolled Adults <133%LowerParticip 589,965 430,744 50.6% 1,952,376 30.2%RateHigherParticip 812,818 635,231 74.6% 1,952,376 41.6%Rate  Kaiser Commission Medicaid and the Uninsured H Perlstadt <perlstad@msu.edu> 16
    17. 17. Medicaid Expansion: Michigan Medicaid Expansion to 133% of FPL Changes in Total Spending 2014-2019 Percent Change in Spending Federal Matching Rates State Federal Total Baseline ReformLowerParticip 2.0% 21.5% 14.8% 65.8% 69.6%RateHigherParticip 3.2% 25.6% 17.9% 65.8% 70.1%Rate Kaiser Commission Medicaid and the Uninsured H Perlstadt <perlstad@msu.edu> 17
    18. 18. Medicaid Expansion: Michigan Estimated Impact of Medicaid Expansion Decisions on Health Centers’ Growth Capacity by 2019 Total Patients No With Medicaid N New % New TotalMedicaid Medicaid Expansion Patients Patients StateExpansion Expansion Impact Eligible Eligible Population on New for for Eligible for Patients Medicaid Medicaid Medicaid 972,900 1,129,500 156,600 76,300 49% 730,000  Estimates based on state proportion of uninsured children and adults (potentially) eligible for Medicaid by Urban Institute Hayes, Shin, and Rosenbaum  By 2014 between 106,000 and 110,000 currently uninsured adults patients served by Health Centers in Michigan will be eligible for Medicaid Bergquist H Perlstadt <perlstad@msu.edu> 18
    19. 19. Building the Exchange: Massachusetts Tool KitsToolkit #1 – Building an Effective Health Insurance ExchangeToolkit #2 – Implementing a Successful Public Outreach and Marketing CampaignToolkit #3 – Determining Health Benefit DesignsToolkit #4 – Mitigating Risk in a State Health Insurance ExchangeToolkit #5 – Effective Education, Outreach and Enrollment for Populations Newly Eligible for Health Coverage MAHealthConnector H Perlstadt <perlstad@msu.edu> 19
    20. 20. Building the Exchange: ProvidersStates need to consider how providers will be invited to participate in the exchange.States are required by the ACA to present provider information on their websites that allows easy comparison across insurance plans (Gold-Silver-Bronze).States may require providers to have necessary information and to participate in any training concerning the website. MAHealthConnector H Perlstadt <perlstad@msu.edu> 20
    21. 21. Building the Exchange: ProvidersIn Massachusetts first phase focused on enrolling low-income uninsured residents who had already been receiving uncompensated care at hospitals and community health centers.Many became eligible for fully subsidized health insurance.State used database of past uncompensated care to users to convert them automatically to public insurance. MAHealthConnector H Perlstadt <perlstad@msu.edu> 21
    22. 22. Building the Exchange: WebsiteInformational materials on websites distributed to community health centers, community based organizations, school nurses, hospitalsHealthcare providers and patient advocate and community service agencies ◦ Use website to assist in signing up residents for coverage. MAHealthConnector H Perlstadt <perlstad@msu.edu> 22
    23. 23. Outreach and Marketing:Community Events, Health Fairs etc.Partners Comcast, CVS, H&R BlockRegular Media—TV, Radio, Print Ads ◦ Less effective as more are insuredDigital Marketing—Browsers Google AdWords ◦ Aimed at uninsured individuals and small businessesDigital Marketing—Social Media ◦ Use TweetDeck to track “followers”; respond to them ◦ MAHealthConnector H Perlstadt <perlstad@msu.edu> 23
    24. 24. Outreach and Marketing: Federally Facilitated StatesCall Centers ◦ By Oct 2013, Center for Medicaid and Medicare (CMS) will have a call center to answer questions about open enrollment, eligibility, and assist in plan comparisons.Small Business Health Options Program (SHOP) ◦ Employer chooses plan and cost sharing level ◦ Employee enters info on self and dependents and then chooses plan based on net price after employer contribution. CMS Consumer Support CMS Small Business H Perlstadt <perlstad@msu.edu> 24
    25. 25. Churning: Medicaid & ExchangeExpanded eligibility for Medicaid to <133% FPLSubsidized health insurance 133% - 400% FPLPeople near the cut-off (133%-200%) will have to shift enrollment as income goes up or down.Estimate churning for families <200% FPL ◦ within first 6 months 35% will shift once ◦ within first year 50% will shift once; 24% twiceDisrupted coverage. May not even seek insurance since low income exempts them from mandate,Increase administrative costs (new enrollments) Sommers and Rosenbaum Health Affairs H Perlstadt <perlstad@msu.edu> 25
    26. 26. Managing the ChurnMinimum guaranteed eligibility period to avoid churning due to short term income fluctuations.Plans dually certified to serve both Medicaid and exchange enrolleesBetter ways to track/ report income changesAlign coverage between Medicaid and exchangeCoordinated marketing between Medicaid, exchanges and community health centersRaise Medicaid eligibility to <200% FPL ◦ Sommers and Rosenbaum / Hwang, Rosenbaum, Sommers H Perlstadt <perlstad@msu.edu> 26
    27. 27. Partnering with CHCsNeighborhood Health Plan (MA carrier) serving Medicaid and other low-income populations partnered with Community Health CentersCurrently has 35 percent of market for unsubsidized individual and small business products offered through the health exchange. * * * * * * * * * *In Michigan County Health Plans ◦ not insurance but provides limited health care services [doctor visits, lab tests, x-rays and prescriptions] to Adult Benefits Waiver (ABW) recipients H Perlstadt <perlstad@msu.edu> 27
    28. 28. AccessAssist low-income people to enter and navigate through the health care system.Help them determine ◦ Which plan is most appropriate for them ◦ How the health plan works, ◦ Costs– premiums, co-pays and deductibles ◦ The role of primary care ◦ Which providers are available, ◦ Finding and selecting providers, ◦ Scheduling appointments. H Perlstadt <perlstad@msu.edu> 28
    29. 29. Tips from OregonOregon will expand Medicaid and is establishing an exchangeConsiderations include:Patient navigator piece – The Exchange Corporation isdetermining the criteria now for what defines a patientnavigator. FQHCs are monitoring to ensure eligibility workersfulfill that role.FQHCs are essential access point - Get training on howexchanges are set up and how to navigate the portal.Oregon Primary Care Association is weighing in on theessential benefits package required by exchange; Workgroupestablished to make sure FQHC model is protected in theexchange.If the federal government does the exchange, how involvedcan we be at this level? Who do they consult with?Information based on conversation with Mary Falls-Staley, Provider Outreach Coordinator, Office of Client and CommunityServices - Office of Healthy Kids, Oregon 29
    30. 30. Tips from Massachusetts Network of more than 50 CBOs in Massachusetts trained to provide outreach & enrollment assistance to consumers through rollout, implementation, and post implementation. Without outreach efforts, enrollment wouldn’t have been as successful. CBOs were given grants for outreach & enrollment, so it would help to seek funding. (MCO, state Medicaid agency, private foundations). State Medicaid staff didn’t do any enrollments themselves, they would mail a blank application or advise you to go to an outreach grantee. Health Centers & CBOs set up financial counseling office. Do follow up with patients. Assisting organizations get copies of notices sent to clients, which is pivotal to make sure folks are informed on enrolling in the appropriate coverage.Information based on conversation with Kate L. Bicego, Consumer Education & Enrollment Manager, HealthCare For All, Massachusetts 30
    31. 31. Tips from Massachusetts Health Care For All is community based advocacy organization - operates a toll-free helpline that people can use statewide. Operators are trained in exchange technical assistance, website navigation, and explaining terminology; offers multiple languages) Outreach methods: health fairs were effective way to enroll people (take help line staff w/laptops to complete applications in real time), make sure that outreach materials were consumer friendly and in multiple languages, use faith-based community (people trust them), ethnic media channels (radio, papers, etc.), outreach and enrollment in small businesses, local neighborhood stores, barbershops, auto repair shops, hospital emergency rooms and CHCsInformation based on conversation with Kate L. Bicego, Consumer Education & Enrollment Manager, HealthCare For All, Massachusetts 31
    32. 32. References Bergquist, P. (2012) Currently Uninsured Health Center Patients That will become Medicaid Eligible in 2014. Michigan Primary Care Association. Hayes, KJ, Shin, P and Rosenbaum, S, (2012) How the Supreme Court’s Medicaid Decision May Affect Health Centers: An Early Estimate. Policy Research Brief #30. Geiger Gibson/ RCHN Community Health Foundation Research Collaborative. George Washington University. Available at: http://sphhs.gwu.edu/departments/healthpolicy/dhp_publications/pub _uploads/dhpPublication_9BB1853A-5056-9D20- 3D3DCBB99318306E.pdf Hwang, A, Rosenbaum, S and Sommers, BD (2012) Creation Of State Basic Health Programs Would Lead To 4 Percent Fewer People Churning Between Medicaid And Exchanges Health Affairs June 2012 31:61314-1320 H Perlstadt <perlstad@msu.edu> 32
    33. 33. References Kaiser Commission on Medicaid and the Uninsured (2011) Medicaid Coverage and Spending in Health Reform: National and State-by-State Results for Adults at or Below 133% of FPL Available at: http://www.kff.org/healthreform/upload/Medicaid-Coverage- and- Spending-in-Health-Reform-National-and-State-By-State- Results-for-Adults-at- or-Below-133-FPL.pdf MAHealth Connector Health Reform Toolkit Series: Resources from the Massachusetts Experience. Available at:  https://www.mahealthconnector.org/portal/site/connector/menuitem.d7b34e8 8a23468a2dbef6f47d7468a0c?fiShown=default CMS Consumer Support: Web and Call Centers Available at:  http://cciio.cms.gov/resources/files/hie-consumer-support-web-call-center.pdf CMS Small Business Health Options Program. Available at: http://cciio.cms.gov/resources/files/Files2/15_shop.pdf.pdf Sommers, BD and Sara Rosenbaum S (2011). Issues In Health Reform: How Changes In Eligibility May Move Millions Back And Forth Between Medicaid And Insurance Exchanges Health Affairs February 2011 30:228-236; H Perlstadt <perlstad@msu.edu> 33
    34. 34. Questions?For further information, please contact: Harry Perlstadt, PhD, MPH Medical Sociologist and Professor Emeritus Michigan State University 517.316.5658 perlstad@msu.edu Doug Paterson, MPA Director of Public Policy, MPCA 517.827.0463 dpaterson@mpca.net Natasha Robinson CHIPRA Program Specialist, MPCA 517.827.0476 nrobinson@mpca.net