Habits of Highly Effective Assisters: Post-Enrollment Strategies

© 2016 Enroll America | StateOfEnrollment.org
Good morning!
There should be two notecards on your chair.
Please include your name on the front. We’ll
collect these as part of today’s discussion.
Thank you!
Before we get started…
On one, please write one
“tried and true” tip that
has helped you be more
effective at providing
post-enrollment
assistance.
On the other, please write
one challenge you face
that you hope to learn new
ways to address today.

Kristen Isaac, Jeff Parmelee, Kevin Simpson, Elizabeth Colvin, Lida Galindo | 05.12.2016
Habits of Highly Effective Assisters:
Post-Enrollment Strategies

Notice of Benefit and Payment Parameters for
2017:
“… post enrollment and other assistance includes
assisting consumers with applying for exemptions
from the individual shared responsibility payment
that are granted through the Exchange, with
understanding the process of filing Exchange
appeals, and with understanding basic concepts
and rights related to health coverage and how to
use it.”
Definition of post-enrollment assistance

1. Leave the room with at least
one new tip, idea, or strategy to
try to better provide post-
enrollment assistance.
2. Meet at least one new person
who can help you as you do this.
TIP: Share not only what but how.
Be descriptive!
Goals for today

I. Brief introductions and opening remarks
from panelists (35 minutes)
II. Break into groups (30 minutes)
• We’ll use your notecards to shape the breakout
group topics!
III. Reconvene and Share (20 minutes)
Session format

Rachel Linstead Goldsmith (moderator)
Enroll America
Follow-up calls to enrollees
Kristen Isaac, Westside Family Healthcare (DE)
Partnering with providers on post-enrollment
Jeff Parmelee, Sacramento Covered (CA)
Documents to include for appeals
Kevin Simpson, Marketplace Appeals Group
Carrier/Marketplace communications with enrollees
Elizabeth Colvin, Insure Central Texas/Foundation Communities
Post-enrollment focus groups
Lida Galindo, Servicios de la Raza (CO)
Workshop speakers

FOLLOW-UP CALLS TO
ENROLLEES
Kristen Isaac, MPH, Outreach Coordinator
Westside Family Healthcare

9
Enrollee follow-up calls = Identifying
issues requiring assistance
Meet with your staff: Walk through draft materials for input and
training
Think about who you’ve helped: What kind of situations did you
encounter during OE3? What kind of post-enrollment issues would
you have?
Pilot the materials: Make an initial round of calls to a subset of
enrollees and re-assess your process and materials
Be calculated: Think about strategic messaging to include (i.e. OE4
dates, tax fraud, etc.)
Create your materials: Enrollee call list, call script, data collection
method

Enrollee Call Script Excerpt

PARTNERING WITH
PROVIDERS ON POST-
ENROLLMENT
Jeff Parmelee, Project Manager
Sacramento Covered

12
• Health Net recognized the increase of people insured due
to ACA, but also an increase in emergency dept. visits
• Insured people were still using the E.D. for primary care
Health insurance ≠ Health Access
• We partnered with local hospitals to change the trend via:
• Emergency Dept. Navigators (establish PCP, follow-up care)
• Pediatric Health Navigators (establish PCP, follow-up care)
• Referrals from hospitals (Kaiser, Dignity, U.C. Davis)
Partner with providers & hospitals to reach new
enrollees
Receive
referrals
from
hospital
personnel
Contact &
educate
patients
Determine
health
insurance
needs
Assist w/
enrollment
(if needed)
Assist w/
healthcare
navigation
and usage

13

ASSISTING CONSUMERS
WITH MARKETPLACE
ELIGIBILITY APPEALS
Kevin Simpson, Director
Marketplace Appeals Group, Centers for Medicare and
Medicaid Services

1. Make sure the issue is appealable.
Common invalid appeals include complaints about the accuracy of
tax forms (1095A), issues related to disenrollment/reinstatement
related to non-payment of premiums, issues not yet decided by the
Marketplace.
For the Quickest Resolution of a Problem

2. Provide relevant documentation.
Currently, the most time-consuming element of the appeal process is
obtaining appeal documentation from consumers.
For example, documentation of income is essential in cases involving
the award/reinstatement of APTC. Other documents may relate to
reasons for exemptions, citizenship/immigration status, or loss of
other coverage for SEP cases.
For the Quickest Resolution of a Problem

MARKETPLACE/CARRIER
COMMUNICATIONS
Elizabeth Colvin
Insure Central Texas/Foundation Communities

Post enrollment includes assisting
consumers with rights related to coverage

Triage on data matching issues
Do the submitted documents prove the
income on the application?
Does the cover letter clearly explain in 1-2
sentences why the estimated income on the
application is different from past years?
Are the “government dollars” the correct
gross numbers?
Is there missing income that would have
been reported to IRS?

SELF-EMPLOYMENT LEDGER
NAME: _______________________________________________________
TYPE OF BUSINESS: _____________________________________________
DATES COVERED: ______________________________________________
GROSS INCOME: ______________________________________________
TOTAL EXPENSES: ______________________________________________
ADJUSTED INCOME: ____________________________________________
INCOME (money received) EXPENSES (costs)
Date
received
Type of Income Amount
Received
Date
Paid
Type of Expense Amount Paid
TOTAL
Verification of 2016 Income for Application # _______________
How I earn my money:
Example: I am a full-time musician and my income varies month to month.
Why my income in 2016 is different from past years:
Example: I quit my full-time job in 2014 to become a full-time musician so my income in 2016 will be
much lower than in previous years.
My estimated income for 2016:
(needs to match the amount on the current Marketplace application):
Example: My estimated income for 2016 is based on my income from the past two months.
Average income of $1,112 per month = $1,112/month x 12 months= $13,344
The attached documents support my estimated income for 2016:
(only include documents that clearly support the estimated income):
I have attached my self-employment ledger showing my income and expenses for the past 2 months:
November profit = $500
December profit = $1,225
Monthly average income (profit) = $1,112
Estimated income for 2016 = $1,112 x 12 = $13,344
I attest that the income information I am submitting is true and accurate.
Signature
Printed Name & Date
Income verification

POST-ENROLLMENT FOCUS
GROUPS
Lida Galindo
Servicios de La Raza

Special populations need special care:
Using focus groups to engage enrollees
Focus Groups
Partnership
Identification
Objective
Recruitment
Strategy
Implementation
Findings

Sample material: Adelante Con La Salud

• Make enrollee follow-up calls to identify consumer issues
requiring assistance
• Partner with providers and hospitals on post-enrollment
• Make sure appeals are the right course of action and include the
correct documents
• Post enrollment assistance includes assisting consumers with
rights related to coverage – such as carrier/Marketplace
communications
• Post-enrollment focus groups allow you to design materials that
will best reach your consumer base
Key takeaways

1. Introductions (name, role, organization, state)
2. Describe the nature of the challenge.
3. What things have people tried in order to solve
the problem (or work around it)?
4. What needs to happen for progress to be made
on this issue for OE4?
5. Are there tools or resources that would make it
easier?
Discussion

Habits of Highly Effective Assisters: Post-Enrollment Strategies

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