While the enrollment community has already made significant progress in connecting the uninsured to coverage over the last two open enrollment periods, action must be taken to address a crucial element in helping consumers maintain coverage —annual renewal. Come learn directly from Michigan Primary Care Association staff that have been actively involved in developing and implementing innovative strategies, materials, and partnerships to increase health coverage retention rates.

1.
1

2. In
March,
the
Office
of
the
Assistant
Secretary
for
Planning
and
Evalua=on
(ASPE)
at
the
Department
of
Health
and
Human
Services
released
an
enrollment
report
summarizing
the
renewal
ac=vity
during
the
second
open
enrollment
period
in
the
health
insurance
marketplace.
Of
those
nearly
9
million
enrolled
in
states
using
the
HealthCare.gov
plaJorm,
53%
were
new
enrollees,
whereas
47%
were
covered
for
all
or
part
of
2014
and
were
renewing
their
coverage.
So
it’s
important
to
remember
that
more
than
half
of
consumers
signed
up
now
will
be
new
to
that
renewal
experience
later
this
year.
Within
the
marketplace,
consumers
can
choose
to
ac=vely
renew
their
coverage,
or
they
can
be
auto-­‐renewed
in
the
same
plan
they
had
last
year.
Slightly
more
than
half
ac=vely
renewed
their
coverage
during
the
second
open
enrollment
period
for
2015
(with
the
rest
geWng
auto-­‐renewed).
To
drill
down
further,
a
liYle
more
than
half
(56
percent)
of
those
who
ac=vely
renewed
switched
plans
with
the
rest
ac=vely
renewing
into
the
same
plan
as
they
were
enrolled
in
2014.
This
exceeded
ini=al
expecta=ons,
but
there
is
always
room
to
grow.
2

3. To
beYer
understand
consumer
experiences
with
renewal,
Enroll
America
conducted
mul=ple
surveys
among
those
on
our
consumer
email
list
of
over
1.2
million
subscribers
during
and
a[er
the
close
of
the
second
open
enrollment
period.
Roughly
83%
of
Enroll
America
consumers
surveyed
said
they
at
a
minimum
compared
their
plan
op=ons
during
the
renewal
process,
which
is
good
news.
But
for
marketplace
coverage,
even
with
auto-­‐renewal,
and
more
vital
for
consumers
with
Medicaid
and
CHIP
that
may
lose
coverage
otherwise,
it’s
so
important
for
the
enrollment
community
to
maximize
consumer
engagement
during
the
renewal
process
so
that
people
stay
covered
in
the
best
coverage
that
fits
their
needs.
Recognizing
that
the
Medicaid
and
CHIP
programs
and
renewal
process
can
vary
from
state
to
state,
we’re
pleased
that
experts
from
the
Michigan
Primary
Care
Associa=on,
who
have
designed
a
successful
outreach
and
enrollment
program
in
their
state,
are
willing
to
share
strategies
that
other
organiza=ons
can
consider
implemen=ng
in
states
and
communi=es
across
the
country.
3

4. 4

5. 5

6. 6

7. Medicaid/CHIP
Data:
Based
on
the
51
states
(including
the
District
of
Columbia)
that
provided
enrollment
data
for
February
2015
reported
over
70.5
million
individuals
were
enrolled
in
Medicaid
and
CHIP.
This
enrollment
count
is
point-­‐in-­‐=me
(on
the
last
day
of
the
month)
and
includes
all
enrollees
in
the
Medicaid
and
CHIP
programs
who
are
receiving
a
comprehensive
benefit
package.
Marketplace:
14
State-­‐based;
3
Federally-­‐supported
State-­‐based;
7
Partnership;
27
Federally-­‐facilitated
7

8. Almost
half
of
those
without
insurance
at
the
start
of
Open
Enrollment
in
10/2013
had
not
had
health
insurance
for
over
5
years,
or
had
never
been
insured.
8

9. Once
consumers
are
enrolled,
staying
covered
isn’t
guaranteed.
Disenrollment
occurs
for
several
reasons:
Some
reasons
are
a
natural
part
of
life
–
Medicaid
recipients
can
lose
their
eligibility
through
an
increase
in
income
or
they
can
acquire
other
health
insurance.
They
can
also
“drop
out”
or
lose
coverage
(o[en
uninten=onally)
due
to
administra=ve
barriers
and
lack
of
knowledge
of
the
health
coverage
system
Administra=ve
process
that
require
addi=onal
documenta=on
of
income,
immigra=on
status,
and
other
criteria
affect
people’s
renewal.
Cost
can
be
a
factor,
or
income
changes
that
move
people
from
Medicaid
eligibility
to
eligibility
for
tax
credits
can
cause
people
to
go
without
insurance.
9

10. 10

11. 11

12. Last
year,
consumers
who
did
not
take
ac=on
to
update
their
income
and
receive
new
eligibility
for
APTC
&
CSR,
maintained
the
same
level
of
financial
assistance
from
the
previous
year.
12

13. 13

14. 14

15. 15

16. States
are
all
moving
forward
but
not
at
the
same
pace.
The
Kaiser
Family
Founda=on
brief
“Modern
Era
Medicaid
“
explained
the
differences
among
states
sta=ng,
“similar
to
enrollment
processes,
the
ACA
calls
for
new
highly
automated,
paperless
renewal
processes
for
Medicaid
and
CHIP.
When
possible,
states
must
use
available
data
to
renew
coverage
automa=cally
(also
called
ex
parte
renewal).
Many
states
are
s=ll
implemen=ng
and
transi=oning
to
these
new
processes,
given
a
range
of
challenges
including
developing
system
capacity
to
process
automated
renewals,
transferring
data
for
exis=ng
enrollees
from
old
legacy
systems
to
new
systems,
and
crea=ng
no=ces
for
individuals.
In
the
interim,
a
number
of
states
are
relying
on
mi=ga=on
strategies
such
as
mailing
forms
to
individuals
to
request
the
informa=on
needed
to
complete
renewal.”
–
Kaiser
Modern
Era
Medicaid
16

17. Knowing
that
we
have
a
sizable
group
of
people
who
will
need
guidance
to
navigate
renewal
successfully,
and
that
renewal
is
not
standard
across
health
coverage
programs
and
across
states,
what
approaches
should
we
take
to
prepare
both
enrollment
assisters
and
consumers?
17

18. Renewal
Webinar
details:
— One-­‐hour
webinar
and
was
recorded
and
archived
online
— Provided
screen
shots
of
the
online
and
paper
renewal
forms
and
prac=cal
=ps
from
CACs
— AYendees-­‐
state-­‐wide
human
service
organiza=ons
and
partners
Michigan
Renewal
Challenges:
• redetermina=on
process
is
the
same
for
MAGI
and
non-­‐MAGI
Medicaid
Health
Coverage
• the
system
is
set
up
to
screen
for
eligibility
for
all
benefits,
not
just
health
coverage
• No=ces
are
difficult
to
understand
and
don’t
come
in
a
logical
order
• Very
=ght
turnaround
for
submiWng
requested
forms
and
proofs
of
income
• Asset
informa=on
is
required
in
online
renewal
18

19. Renewal
&
Re-­‐enrollment
Basics
for
2015-­‐
CCIIO
Renewals,
Reconcilia8on
and
Exemp8ons-­‐
Center
on
Budget
&
Policy
Priori=es
Understanding
Marketplace
&
Medicaid
Renewal
Approaches-­‐
Georgetown
Center
for
Children
&
Families
and
MPCA
19

20. 20

21. Consumers
come
to
assisters
with
varying
knowledge
and
awareness
about
health
coverage
and
access
to
care.
Our
role
as
assisters
is
to
fill
gaps
in
knowledge.
In
many
cases
the
only
opportunity
enrollment
assisters
have
to
educate
is
during
the
enrollment
encounter;
which
is
why
it
is
important
to
include
renewal
educa=on
at
the
=me
of
enrollment.
21

22. One
way
MPCA
CACs
and
our
network
of
assisters
brings
renewal
educa=on
into
the
enrollment
is
through
use
of
our
enrollment
worksheets.
The
worksheets
outline
the
steps
to
successful
enrollment
in
coverage
and
what
consumers
can
expect
a[er
they
get
covered.
Assisters
use
these
worksheets
to
guide
conversa=ons
with
consumers
and
offer
them
as
a
takeaway
for
the
consumers
records.
22

23. At
the
end
of
the
enrollment
encounter,
MPCA’s
CACs
use
this
Enrollment
Quality
Survey
to
ensure
that
their
message
has
been
understood.
23

24. Assisters
can
pair
MPCA’s
Medicaid
Renewal
Guide
with
the
enrollment
worksheets.
The
guide
includes
important
details
and
steps
related
to
the
renewal
=meline
and
how
to
complete
the
renewal
process.
24

25. The
website
features:
• Step
by
step
guides
for
what
happens
a[er
a
coverage
applica=on
is
submiYed
• Resources
for
all
coverage
programs
in
one
place
(HMP,
Marketplace,
Medicaid,
&
MIChild)
• Downloadable
worksheets
for
assisters
to
complete
with
clients
with
blanks
to
write
in
client-­‐specific
informa=on
• Key
phone
numbers
and
links
• Informa=on
about
health
plans
including
phone
numbers,
handbooks
and
provider
directories
• Suppor=ve
client
educa=on
on
post-­‐applica=on
health
behaviors
• Informa=on
about
cost-­‐sharing,
retaining
and
renewing
coverage
• Links
to
resources
for
filing
hearings,
local
advocates
etc.
25

26. 26

27. MPCA
includes
renewal
messaging
in
all
educa=onal
and
outreach
materials.
These
resources
are
editable
and
available
to
everyone
in
our
OE
Toolkit.
27

28. The
grant
focused
on
three
simple
steps:
1. Ensure
families
understand
how
and
when
to
reapply
for
coverage
2. Remind
families
to
renew
as
their
redetermina=on
date(s)
approaches
3. Offer
assistance
with
redetermina=on
for
families
over-­‐the-­‐phone
and
at
their
Health
Center
Messaging
was
=med
to
compliment
the
Medicaid
renewal
=meline
set
out
by
the
state.
For
example:
The
first
message
is
sent
during
the
3rd
week
of
the
11th
month
because
we
know
the
state
produces
redetermina=on
leYers
between
the
10th
&
17th
day
of
the
11th
month
of
coverage.
28

29. 29

30. Mobile
phone
ac=vity:
Text-­‐
80%
Internet-­‐
56%
Email-­‐
50%
Health-­‐
31%
30

31. 31

32. 32

33. Ini$al
text
messages
33

34. 34

35. Par=cipants
who
choose
to
interact
with
the
messages
are
connected
to
their
Health
center.
Staff
can
find
the
client
in
our
database,
check
their
redetermina=on
date
and
determine
an
appropriate
course
of
ac=on
to
take
records
of
these
interac=ons
are
noted
in
the
database.
Those
who
have
renewed
their
insurance
successfully
receive
a
follow
up
sa=sfac=on
survey
with
a
self
addressed
and
stamped
envelope
to
return
it
to
us.
Those
who
did
not
renew
receive
a
follow
up
leYer
to
re-­‐enroll
as
a
“last
ditch”
effort.
35

36. 36

37. 37