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IN THE MIX: PREPARING TO BE ASSISTERS

Prepared by California Coverage and Health Initiatives (CCHI)

June 2013

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Our Agenda

Enrolling California’s Uninsured in Health Coverage

Role of the Exchange in Shaping the Assister/Counselor Roles

Enrollment Entity Roles and Responsibilities In-Person Assisters Navigators Certified Application Counselors

Which Role is Right for You? Training Opportunities

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Enrollment System Guiding Principles

CCHI believes California’s enrollment system should: Build off the strengths of existing

organizations Involve small CBOs Help assisters/enrollment counselors in

their role

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California’s New Health Insurance Marketplace

www.healthexchange.ca.govhttp://www.dhcs.ca.govwww.coveredca.com

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Who Will Need Help Enrolling in Coverage?

Source: Covered California

In 2014, 5.3 million Californians will be eligible to purchase insurance through the exchange : 2.6 million will qualify for premium

assistance All will benefit from guaranteed

coverage

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Who Are California’s Uninsured?

By ethnicity:

Source: Covered California

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Enrollment Assistance in California

Covered California has several types of Enrollment entities and Assister/Counselors: Paid Assisters/Counselors

In-Person Assisters Navigators

Unpaid Assisters/Counselors

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What Does the Enrollment Assistance Program Aim to

Do?

Source: Families USA

It engages Enrollment Entities and individual counselors who: Conduct outreach and education to help

people figure out their coverage options Help consumers and small employers

learn about and enroll in coverage Help with the application process,

translate materials and breakdown barriers

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Who Can Be an Enrollment Entity?

Community Based Organizations (CBOs) and other consumer focused groups

Organizations with existing relationships with key eligible populations

Assisters/Counselors cannot: Have conflicts of interest Be health insurers or accept any form of

payment from insurers related to enrollment

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What Will the Enrollment Entities and Enrollment Counselors’ Role Look Like?

Covered California is in the process of determining: What types of entities are eligible to be

Navigators/IPAs How they will be paid Oversight and monitoring How Enrollment Assistance Program will

work with the Medi-Cal population

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Program OverviewEnrollment Assistance

ProgramUnpaidHealth Care

Providers

Agents

Other Entities

PaidIn Person

Assisters$58/

Enrollee$25/Re-enrollee

NavigatorsGrant

Program

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In-Person Assistance Program (IPA) Overview

IPAsFunding Source Establishment Costs

Compensation

Fee-for successful initial enrollment

into Covered California QHP ($58)

or renewal ($25)

Program starts: October 2013Source: Covered California

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IPA Program Timeline

Source: Covered California

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Navigator Requirements

There are six major navigator requirements: Provide outreach and education Assist with enrollment Expertise in eligibility and enrollment Offer services in a fair and impartial manner Provide referrals to ombudsmen or other

consumer assistance programs Make available information in a manner that

is culturally and linguistically appropriate

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Navigator Program Overview

Navigators

Funding Source Fees on Health Plans

Compensation Grant program based on enrollment targets

Program starts:

January 2014, but initial payments may

be delayedSource: Covered California

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Navigator Program Timeline

Source: Covered California

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Comparing IPA and Navigator Programs

Roles & Responsibilities IPA Program Navigator Program

Conduct public education activities to raise awareness of the availability of Covered California products

  X

Distribute fair and impartial information concerning enrollment into qualified health plans

X X

Facilitate enrollment into qualified health plan available through Covered California

X X

Provide referrals to Consumer Assistance Programs

X X

Provide information that is culturally and linguistically appropriate

X XSource: Covered California

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Enrollment Assistance Application Process

Eligible organizations and their employees may apply to register for the In-Person Assistance or Navigator Program by: 1. Submitting a completed application2. Passing the Assister Fingerprinting and

Criminal Record Check3. Completing the required training

established described in Section 6660 and pass the exam

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A Third Role: Certified Application Counselors (CACs)

Covered California and DHCS will certify staff and volunteers to become CACs, who will: Help consumers apply and enroll in Exchange

coverage and Medi-Cal Provide “the same core application assistance

services” and have similar training requirements and conflict of interest standards to other enrollment assistance roles

Not be paid by the Exchange Be unable to charge fees to consumers

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What is the Role of Insurance Agents?

In California agents or brokers will: Enroll individuals and small

employers in qualified health plans and public programs

Assist individuals in applying for premium assistance/tax credits and cost-sharing reductions in exchanges

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Agents and Enrollment Entities Working Together

Nonfinancial working partnerships between agents and Enrollment Entities are encouraged

Regulations prohibit financial relationships between CEEs and CECs and anyone who holds a current license from California Department of Insurance

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Which Role to Play?

Organizations will not be able to pursue both the IPA and Navigator role and should consider the following: Does your organization want to offer IPA

and collect a per successful application fee that is only funded until 2015?

OR Go after a grant that is likely to be

funded over a longer period of time?

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Requirements in Process

Covered California has finalized the IPA portion of the Enrollment Assistance Program regulations. These provide guidance on: Background checks, fingerprinting and

liability insurance for individual assisters Types of trainings and training topics Relationships between agents and Certified

Enrollment EntitiesFull-text of the regulations can be found here: http://www.healthexchange.ca.gov/BoardMeetings/Documents/June%2020,%202013/Enrollment%20Assistance%20Regulations%20(FINAL).pdf

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Training and Oversight

Training standards for Certified Enrollment Entities and Counselors include: Addressing the needs of underserved and

vulnerable populations Familiarity with qualified health plans (QHPs),

public insurance programs, premium assistance/tax credit and cost sharing

Understanding eligibility and enrollment rules and procedures

Adherence to privacy and security requirements

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Enrollment Program Training Topics

Basic concepts about health insurance and the exchange, enrollment and individual responsibility

Outreach methods and strategies

Eligibility, application requirements and appeals

Enrollment procedures, processes and tracking systems

QHP/Medi-Cal/Healthy Families operations, plan options and benefit limits

Premium assistance/Tax Credits, deductibles and cost-sharing requirements

Understanding of cultural and linguistic standards and the needs of underserved and vulnerable populations

Access standards for individuals with disabilities

Referral to appropriate agencies for additional information

Code of Conduct and Ethics Customer services

standards Privacy and security

standards

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CCHI Member/Partner Areas of Expertise

Premium assistance/Tax Credits, deductibles and cost-sharing requirements

Understanding of cultural and linguistic standards and the needs of underserved and vulnerable populations

Referral to appropriate agencies for additional information

Access standards for individuals with disabilities

Code of Conduct and Ethics

Customer services standards

Privacy and security standards

Basic concepts about health insurance and the exchange, enrollment and individual responsibility

Outreach methods and strategies

Eligibility, application requirements and appeals

Enrollment procedures, processes and tracking systems

QHP/Medi-Cal/Healthy Families operations, plan options and benefit limits

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New Skill Sets

Basic concepts about health insurance and the exchange, enrollment and individual responsibility

Outreach methods and strategies

Eligibility, application requirements and appeals

Enrollment procedures, processes and tracking systems

QHP/Medi-Cal/Healthy Families operations, plan options and benefit limits

Premium assistance/Tax Credits, deductibles and cost-sharing requirements

Understanding of cultural and linguistic standards and the needs of underserved and vulnerable populations

Access standards for individuals with disabilities

Referral to appropriate agencies for additional information

Code of Conduct and Ethics Customer services

standards Privacy and security

standards

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Next Steps for Your Organization

Educate your Board and community partners about the programs

Consider your organizational structure and what role might work best for your organization

Develop a plan that includes training, goals and a readiness timeline

Complete the Enrollment Entity Interest form here: https://assisters.ccgrantsandassisters.org/

Officially apply to become a Certified Enrollment Entity

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Reports Referenced in Presentation

Covered California, Assisters Program: In-Person Assistance and Navigator Webinars

Families USA, Interested in helping with enrollment in the federal insurance marketplaces?

State Health Reform Assistance Network, Designing Consumer Assistance Programs: Resources from the Field

CCHI and others, Health Benefit Navigator Credentialing, Training and Quality Assurance in California

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Who to Contact:

INSERT your organization’s contact information HERE

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Feedback or Questions about this Presentation?

Suzie ShupeExecutive Director

California Coverage & Health Initiatives707-527-9213

sshupe@cchi4families.orgwww.cchi4families.org