Presented by: Johnston Associates
Sponsored by: Alliance InstituteNovember 15, 2013
Morning Plenary: Implementation of The Affordable Care Act
The Affordable Care Act & Access to Health Care Along the Gulf Coast: A Symposium
We need Access to Affordable Health Care on the Gulf Coast
Morning Plenary: Panelists
Marjorie PettyRegional DirectorRegion VIUS Department of HHS
Oscar GomezHealth Outreach Partners
Tony GarrEnroll America
Moderated by: Philip W. Johnston
Health Insurance Marketplace 101
The Marketplace is open!
Find healthoptions that meet
needs and fit
careyour your
budget.
November 2013
Presented by Marjorie Petty, HHS Regional Director, Region VI
GEOGRAPHIC DIVERSITYOF THE UNINSUREDNumber Uninsured Percent Uninsured
ch 2010, President Obama signed the
The Health Care Law
In MarAffordable Care Act into law allowing
• Young adults up to age 26 totheir parents’ plan
Additional drug coverage for with Medicare
stay on
• people
••
More free preventive services
Lifetime limits removed from health insuranceAnd more starting January 1, 2014•
November 2013 Health Insurance Marketplace 101 2
What’s new on January 1, 2014?
Discrimination due to pre-existing conditions orgender is prohibited
Annual Limits on Insurance Coverage are eliminatedAdvanced Premium Tax Credits are availableThe Small Business Tax Credit will increaseMore people are eligible for Medicaid (in some states)
Coverage through
beginsthe Health Insurance Marketplace
• As early as January 1, 2014
November 2013 3Health Insurance Marketplace 101
What is the Health Insurance Marketplace?
Part of the Affordable Care Act of 2010• Where qualified individuals directly compare private
insurance options
Known as Qualified Health Plans (QHPs)Can directly compare on the basis of price, benefits, quality, and other factorsAlso known as Exchanges or Obamacare
health
•
•
Small Business Health Options Program (SHOP)• Marketplace for small businesses
November 2013 Health Insurance Marketplace 101 4
The Marketplace…
It’s a way to shop for health coverage••
Simplifies the search
With one streamlined application an individual or familycan explore every qualified insurance plan in the area
Most people are able to get a break on costs• 90% of people who are currently uninsured will qualify for
savings on health insurance
Clear options with apples-to-apples comparisons• All health insurance plans in the Marketplace present their
price and benefit information in plain language
November 2013 Health Insurance Marketplace 101 5
Marketplace Establishment
Each state can choose to••
Create and run its own Marketplace
Partner with the Federal Government to run someMarketplace functions• Have a Marketplace establishedthe Federal Government
and operated by
November 2013 Health Insurance Marketplace 101 6
Qualified Health Plans CoverEssential Health Benefits
Essential Health Benefits include at least these 10 categories
• Ambulatory Patient Services• Emergency services• Hospitalization• Maternity and newborn care• Mental health and substance use disorder services,
including behavioral health treatment• Prescription drugs• Rehabilitative and habilitative services and devices• Laboratory services• Preventive and wellness services and chronic disease management• Pediatric services, including oral and vision care (pediatric oral
services may be provided by stand-alone plan)7
November 2013 Health Insurance Marketplace 101
How Qualified Health Plans Can Vary
Some plans may cover additional benefits
You may have to see certain providers or use certain hospitalsThe premiums, copays, and coinsurance are different different plansThe quality of care can varyThe coverage level can vary within each planSome special types of plans are structured differently
in
• Like high-deductible (catastrophic) plans
November 2013 Health Insurance Marketplace 101 8
Plan Levels of Coverage
Lowest PremiumsHighest Out-of-Pocket
Highest PremiumsCosts Lowest Out-of-Pocket Costs
60%
Covered70%
Percent of
80%
Total Cost of
90%
Care Covered
November 2013 Health Insurance Marketplace 101 9
Catastrophic Plans
What is catastrophic coverage?•••
Plans with high deductibles and lower premiums
You pay all medical costs up to a certain amount Includes coverage of 3 primary care visits per year preventive services with no out-of-pocket costsProtects consumers from high out-of-pocket costs
and
•
Who is eligible?••
Young adults under 30 years of age
Those who obtain a hardship exemption from the Marketplace
November 2013 Health Insurance Marketplace 101 10
Small Business Health Options Program(SHOP) Marketplace
A streamlined way for small businesseshealth insurance
Part of the MarketplaceOffers access to Qualified Health PlansWorks with new insurance reforms and
to offer
tax credits to
lower barriers to offering health insurance
SHOP Marketplace Help Desk for employers
• 1-800-706-7893 (TTY 1-800-706-7915)
November 2013 Health Insurance Marketplace 101 11
Eligibility in theIndividual
Marketplace Marketplace eligibility requires you to
•••
Live in its service area, and
Be a U.S. citizen or national, orBe a non-citizen who is lawfully present in
the U.S. forthe entire period for which enrollment is sought
Not be incarcerated• Can apply
charge
Can apply
for Marketplace if pending disposition of
for Medicaid/CHIP at any time
November 2013 Health Insurance Marketplace 101 12
Lower Premium Costs
A refundable or Advanced Premiumthe cost of Qualified Health Plans
Eligibility is based on
Tax Credit (APTC) lowers
• Household income, and family size (at end of year)
Income between 100% to 400% of the federal poverty level (FPL) ($23,550 – $94,200 for a family of four in 2013)
Obtaining qualified health insurance through the Marketplace Ineligibility for government-sponsored coverage, affordable employer-sponsored insurance, or certain other minimumessential coverage
••
November 2013 Health Insurance Marketplace 101 13
Ways to Use a Premium Tax Credit
*You should report changes in household size and income as soon as possible toensure you are getting the right premium tax credit amount and avoid having topay anything back.
November 2013 Health Insurance Marketplace 101 14
Will you get a Will you have toIs your monthly credit on Federal pay back
If you choose to… premium lower? tax return? money?*
Use all of your premium tax credit Use part of your premium tax credit Use none of yourpremium tax credit
Yes Not likely Maybe
Yes Maybe Not likely
No Yes No
Who is Eligible for a Cost-Sharing Reduction?
Eligibility for reduced cost sharing is based on• Income at or below 250% of the FPL ($58,875
annually for a family of four in 2013)
Receiving the Premium Tax CreditEnrollment in a Marketplace Silver-level plan
••
Members of Federally-recognized Indian Tribes
• No cost sharing if income is <300% FPL
November 2013 Health Insurance Marketplace 101 15
Medicaid Eligibility in 2014
States have the option to expand Medicaid eligibility to
• Adults ages 19 – 64 with incomes up to 133% of the federalpoverty level (FPL) ($15,282/year for an individual,$31,322/year for a family of 4 (2013 amounts))
Ensures Medicaid coverage for all children
• With incomes up to 133% of the FPLShifts to simplified way of calculating income to determineMedicaid/CHIP eligibility
• Known as Modified Adjusted Gross Income (MAGI)-basedmethod
November 2013 Health Insurance Marketplace 101 16
Starting in 2014, everyone must either:
OR OR
1. Have Minimum 2. Have a Coverage 3. Pay a feeEssential Exemption (SharedCoverage
They are already covered and don’t need to do anything.
November 2013
They don’t have to get coverage and won’t have to pay a fee for not having coverage.
Health Insurance Marketplace 101
ResponsibilityPayment)
They should consider getting coverage. If they don’t, they will pay a fee.
17
1. What is Minimum Essential Coverage?
If you have coverage from any of the following, you arecovered and don’t have to do anything•••••••
Employer-sponsored, including COBRA and retiree
MedicareMedicaidChildren’s Health Insurance Program (CHIP) Marketplace CoverageIndividual Coverage (outside the Marketplace)
TRICARE or certain types of VA coverage
coverage
About 85% of Americans already have Minimum Essential Coverage.November 2013 Health Insurance Marketplace 101 18
2. Who can get a coverage exemptionnot have to pay a fee?
and
You may get a coverage exemption if you•••••••
Are
AreAre
conscientiously opposed (religious conscience)
a member of a recognized health care sharing ministry a member of a Federally recognized Indian tribe
Don’t make the minimum income required to file taxes
Have a short coverage gap (>3 consecutive months) Suffered a hardshipDid not have access to affordable coverage (cost of available coverage >8% of household income)
••
Were
Wereincarcerated (unless pending disposition of charges)
not lawfully presentHealth Insurance Marketplace 101November 2013 19
3. You May Pay a Fee
You may pay a fee when you file your 2014Federal tax return in 2015 (and thereafter)• If you don’t have minimum essential coverage,
and
You don’t qualify for an exemption•
Paying thecoverage
fee does not provide health
November 2013 Health Insurance Marketplace 101 20
Less than 2% of Americans are expected to have to pay the fee.
You May Pay a Fee (Continued)
You pay the greater of the flat dollar amount or the percentageof income
*Maximum of $285 per family in 2014 (applies to those for whom the $95 peradult/$47.50 per child is less than 1% of income). Higher in subsequent years.
** After 2016 - Plus an increase based on cost of livingNovember 2013 Health Insurance Marketplace 101 21
2014 2015 2016 and beyondFlat dollar $95 per adult $325 per adult $695 per adult** amount 50% if under 18* 50% if under 18* 50% if under 18* (annual)
Or Or OrPercentage of 1% of household 2% of household 2.5% of income income income household (annual) income
When You Can Enroll in the Individual Market
Marketplace Initial Open Enrollment Period• October 1, 2013 - March 31, 2014
Annual Open Enrollment Periods• 2014 and beyond, October 15 - December 7
Special Enrollment Periods• Available in certain circumstances during the year
November 2013 Health Insurance Marketplace 101 22
How the Marketplace Works
Health Insurance Marketplace 101November 2013 23
4 Ways to Get Marketplace Coverage
November 2013 Health Insurance Marketplace 101 24
In Person Assistance
Marketplace in person help is available• Certified Assisters
Navigators Non-Navigator assistance personnel Certified Application Counselors
Agents and brokersTo find assistance in your area, go toLocalhelp.HealthCare.gov
••
Visit Marketplace.cms.gov for information on yourbecoming a Champion for Coverage
organization
November 2013 Health Insurance Marketplace 101 25
Marketplace and People With…
Medicare
• Medicare isn’t part of the Marketplace so you don’t need to doanything
COBRA
• You can drop COBRA and enroll in the Marketplace
During the Marketplace Open Enrollment Period Within 60 days of COBRA expiring (Special Enrollment Period)
Pre-existing Condition Insurance Plan (PCIP)
••
Ends December 31, 2013
Need to apply for Marketplace coverage by December 15, 2013, to avoid a break in coverage (no automatic transition)
November 2013 Health Insurance Marketplace 101 26
Key Points to Remember
The Marketplace is a new way to find and buyinsurance
Qualified individuals and small businesses can health insurance that fits their budget
health
shop for
States have flexibility to establish their own Marketplace
Individuals and families may be eligible for lower coststheir monthly premiums and out-of-pocket costs
There is assistance available to help you get the best coverage for your needs
on
November 2013 Health Insurance Marketplace 101 27
Open Enrollment StartedOctober 1, 2013
Last day to enroll for coverage to begin January 1, 2014
December 15, 2013
Coverage can start as early as
January 1, 2014
Open enrollment endsMarch 31, 2014
November 2013 Health Insurance Marketplace 101
Remember the Marketplace’sImportant Dates
AfterMarch 31, 2014,
you can onlyenroll after a
qualifying eventor during the
next annual openenrollment
(Oct 15, 2014 –
28
Dec 7, 2014).
Marketplace.cms.gov
Get the latestresources to helppeople apply, enroll,and get coverage2014
in
November 2013 Health Insurance Marketplace 101 29
Click “Get Training” for helpful videos
onnected
Want more informationabout the Marketplace?
Stay Connected• Sign up to get email and text alerts at
HealthCare.gov/subscribe
CuidadoDeSalud.gov for Spanish• Updates and resources for partner
available at Marketplace.cms.gov
[email protected]/Healthcare.gov
organizations are
••
November 2013 Health Insurance Marketplace 101 30
Alliance Institute: ACA DiscussionNovember 15, 2013
Tony GarrSoutheast State Assistance Manage
Get Covered America Mission
37
Sampling of Our Partners
38
Enroll America’s Mission: Maximize Coverage For Uninsured Americans
1. Educate and Engage 2. Mobilize to Enroll 3. Work with Partners to Ensure System works
Enroll America is executing a national education and enrollment campaign
Successful implementation of ACA requires all-out effort by government, not-for-profits, insurers, hospitals, community health centers, health providers, and others
39
State Presence
40
AlaskaHawaii
As of September 23, 2013
Staff on the ground
Working with partners
Our Research Tells Us…
41
Alabama Assistance
Coordinating Organization: Alabama Arise http://www.arisecitizens.org/index.php/policy-research-topmenu-71/health-topmenu-29
Requesting Enrollment Assistance:o AIDS Alabama, Enroll Alabama: http://www.enrollala.com/o Access Alabama: http://www.alaaccess.com/AHA_Home.aspxo Alabama Primary Health Care Assn Outreach & Enrollment:
http://www.alaaccess.com/AHA_Home.aspxo Healthcare.gov – https://www.healthcare.gov/o Find Local Help: https://localhelp.healthcare.gov/o Call Center: 1-800-318-2596; TTY: 1-855-889-4325o Enroll America: http://www.getcoveredamerica.org/
42
Florida Assistance
Coordinating Organization: Florida Primary Care Association: http://www.fachc.org/Requesting Enrollment Assistance:
o Florida Consumer Services: 1-877-693-5236o Healthcare.gov – https://www.healthcare.gov/o Find Local Help: https://localhelp.healthcare.gov/o Call Center: 1-800-318-2596; TTY: 1-855-889-4325o Enroll America: http://www.getcoveredamerica.org/
43
Louisiana Assistance
Coordinating Organization: Southwest Louisiana AHEC - http://lahealthcarenav.com/
Requesting Assistance:o Reach us by Email at: [email protected] By Phone: North LA - Toll Free - 1-877-946-4644; Central LA - 318-443-2855;
Southwest – Toll Free - 1-800-435-2432; Southeast – Toll Free - 1-866-428-4173o Enrollment Assistance: http://lahealthcarenav.com/request-enrollment-assistance/o Louisiana Primary Care Assn Outreach & Enrollment:
http://lpca.net/main/inside.php?page=Outreach_and_Enrollmento Events in Your Area: http://lahealthcarenav.com/events/o Healthcare.gov – https://www.healthcare.gov/o Find Local Help: https://localhelp.healthcare.gov/o Call Center: 1-800-318-2596; TTY: 1-855-889-4325o Enroll America: http://www.getcoveredamerica.org/
44
Mississippi Assistance
Coordinating Organization: Cover Mississippi - http://coverms.org/
Requesting Enrollment Assistance:o Coordinator: Morgan Miller, [email protected] or 601-355.0025 (p)o Cover Mississippi: http://coverms.org/index.php/site/helpo Mississippi Primary Care Assn Outreach & Enrollment:
http://www.mphca.com/outreach-and-enrollment-resourceso Events in Your Area: http://coverms.org/index.php/eventso Healthcare.gov – https://www.healthcare.gov/o Find Local Help: https://localhelp.healthcare.gov/o Call Center: 1-800-318-2596; TTY: 1-855-889-4325o Enroll America: http://www.getcoveredamerica.org/
45
46
As A Result, Enrollment Will Be A Challenge To Overcome
Lack of awareness provides opportunity for education with effective messaging
Many of the uninsured still don’t know about their options
43%
Source: Enroll America, November 2012
of the uninsured don’t know about the new health insurance marketplace options
November 2012 August 2013
Source: Kaiser Family Foundation, August 2013
Enroll America still has work to do, but the uninsured are hearing more and more about the new options available to them
78%of the uninsured don’t know about the new health insurance options
Segmentation
47
Unnecessary & Uninterested – 24%• Skeptical Young Men
Reluctant, but Reachable – 21%• Young, Diverse Families
Connected, Low-Income Women – 11% • Medicaid, CHIP, SNAP connection
Desperate & Believing – 13%• Sick, Poor, Least Educated
Insured & At-Risk – 11%• Young, Under 250% FPL
Campaign Strategies and Tactics
48
Strategic Partners
Community Engagement
Data & Results Driven
Earned Media
Digital & Social Media
Paid Media
Surrogates
In-reach and Outreach tools
In-Reach
Text (and/or voice) messaging
Newsletter
Website
Social media
Direct mail
Appointment cards
On-site promotion
49
Outreach – Commitment Card
50
Outreach
51
Modeling And Testing Connect Individuals With Most Effective Messages And Tactics
Without Modeling, Campaign Would Miss Millions of Uninsured
Modeling Identifies Uninsured at
Individual Level
Additional Testing Identifies Best
Message + Tactic
Example: In Houston, 120K out of 800K uninsured live in areas
with low uninsured rates
Example: Individual level targeting increases efficiency
of volunteer outreach
Example: Experiments identify which individuals respond
better to mail or phone calls
119,508
Houston Uninsured Map Example Neighborhood
9% 49% 7%
23%54% 35%
Example Tactics + Message
Mail – Security Msg.
Call – Cost Msg.
52
53
Coordinate Outreach
54
Without coordination, what happens?o Limited resources are over-utilized & duplicatedo Public is confusedo Resources are wasted
With Coordination:o Consumers get the care they need but not more than they
needo Confusion is minimizedo Resources are better targeted
For More Information:
Tony [email protected]
615-603-9747 http://www.getcoveredamerica.org/http://www.enrollamerica.org/
Implementing the Affordable Care Act: Outreach, Enrollment, Engagement, and Access to Care
The Affordable Care Act & Access to Health Care Along the GulfAlliance Institute SymposiumNew Orleans, LouisianaNovember 15, 2013
Oscar C. Gomez, CEOHealth Outreach Partners
Our vision is a country in which all people are valued and in which equal access to quality health care is available to everyone, thus enriching our collective well-being.
Our mission is to build strong, effective, and sustainable grassroots health models by partnering with local community-based organizations across the country in order to improve the quality of life of low-income, vulnerable, and underserved populations.
Health Outreach Partners
Who We Are? Since 1970, Health Outreach Partners (HOP) has
been at the forefront of elevating the importance of outreach, recognizing the critical role it plays in facilitating primary care, case management, health prevention and social services to underserved, vulnerable and/or marginalized populations.
We provide training, consultation, and information services to community health centers, free clinics, primary care associations, and other community based organizations supporting efforts to increase access to health care.
Take a step back and remember that the bigger goal of the Affordable Care Act is to increase access to quality health care.
Health Coverage Expansion/Enrollment is one key strategy to reach that goal.
◦ For low-income, underserved communities health care expansion may or may not be a relevant strategy to reach this goal.
ACA Implementation
Too many people in the U.S. lack coverage
U.S. health care spending is unsustainable
Despite high spending, health outcomes are poor
System emphasizes treatment instead of prevention
Health disparities exist among numerous populations
Why Was the ACA Established In the First Place?
Source: American Public Health Association: August 2012
Connecting Eligible Immigrant Families to Health Coverage and CareBackground: Health Outreach Partners and Kaiser Family
Foundation partnered to examine the impact of Affordable Care Act on immigrant population and how to connect eligible immigrant families to coverage and care
In July and August 2011, HOP held four focus groups with outreach and enrollment workers in DC, Florida, San Francisco, and Los Angeles
Analyzed findings and drafted report Released October 2011
“You can do really great eligibility [work] and get them benefits, but if you don’t do the teaching and education on how to use [the benefits] … you are not actually getting anybody access because they just have no idea that it doesn’t mean go to the ER.”
Outreach Worker, District of Columbia
Quotes from Outreach Worker Focus Groups
“If you are not in the right city and don’t have a car, you might have to take two, three, or four busses to get to a clinic. So you have to leave an hour and a half earlier and you might still have a wait once you get there. And then how long does it take to get home? You might have to take the whole day off work …”
Outreach Worker, San Francisco
Quotes from Outreach Worker Focus Groups
“Just having the access to Medi-Cal [Medicaid] opens up a whole new perception of health. Many people come from countries where there is no preventive health – you go to the doctor when you are deathly ill … We do a lot of education in our program about preventive health and that they get immunizations … So I think just changing their perceptions”
Outreach Worker, San Francisco
Quotes from Outreach Worker Focus Groups
Not as clear cut as it looks…
Citizen: Younger child, born in US
Non-Citizens: Mom, Dad, older child,
Dad’s sister
Lawfully present:
Dad’s sister
Not lawfully present: Mom,
Dad, older child
Key Findings: Enrollment Challenges and Barriers to Accessing Health Care Immigrant families encounter multiple
barriers, often simultaneously, to enrollment and accessing health care including:◦ Fear◦ Confusing enrollment processes◦ Difficulty meeting documentation requirements◦ Language and literacy◦ Limited access or familiarity with technology◦ Maintaining coverage◦ Transportation◦ Access to specialty care
Strategies to Consider Utilize trusted community organizations and
individuals to provide outreach and enrollment assistance
Provide direct one-on-one assistance for enrollment
Educate families about coverage options and enrollment processes
Maximize existing relationships and maintain ongoing contact over time to assist families with renewal and accessing necessary services
More Specific Strategies Form partnerships with trusted community business
and groups Direct one-on-one assistance from someone with a
shared background Educate about options and process List of required documents & alternatives Zero income/cash income forms Cards requesting translation assistance Maintain contact
Recommendations Recommendations include:
◦ Assuring trusted organizations and individuals are adequately prepared and supported to provide outreach and enrollment assistance.
◦ Meet immigrants where they are.◦ Provide simple and welcoming application
and enrollment processes that meet the needs of immigrant families
◦ Strengthen and reinforce messages to dispel fear among immigrant communities.
Changes in Outreach and Enrollment Strategies Strategies targeting newly eligible
populations Strategies will differ across states and
localities New community partners, such as
insurance brokers, small businesses, etc. to reach newly eligible populations
Messages need to be tailored to be effective with newly eligible populations
Needed Increase in Staff Capacity Knowledge of barriers and needs of newly
eligible populations Understanding of changes in health insurance
options Knowledge of new options and processes
specific to State Exchange/Marketplace Capacity to use new technological systems CHC’s Need to Plan and Adjust for Incremental
Cost of Care Customer Service and Cultural Competency at
All Levels of CHC – particularly front desk staff
Needed Education and Messaging Changes affecting those currently insured
by public health insurance Options for newly eligible populations Education to reduce stigma and dispel
myths Messenger Trumps Message – Especially in
Communities That Experience Distrust, Fear, or Marginalization.
Outreach Messages Must Resonate When Patient Walks in Health Center Door
Role of Outreach Reaching people within and beyond patient base Relationship/trust building Unique Marketing for CHC. Builds Brand Over
Time Community relations. Community Collaborations Cultural competency Organizational integration
Framework & Resources
National Outreach Guidelines
National Partners for Outreach Guidelines
Some Helpful Websites Health Outreach Partners www.outreach-partners.org Kaiser Family Foundation www.kff.org Association of Asian Pacific Health Care
Organizations (AAPCHO) www.aapcho.org National Association of Community Health Centers
(NACHC) www.nachc.com Farmworker Justice www.farmworkerjustice.org National Health Care for the Homeless Council
www.nhchc.org
“Outreach makes you realize that health is impacted by many issues beyond just the clinical – to include a person’s income, living conditions, occupation, etc.” “Advocacy is another key outreach principle. A doctor can heal but not necessarily advocate. Outreach workers are consistent advocates for access to health care and to ensure that the patient gets all the care needed.”
Marina Mezey, M.D.Current HOP Board Chair
Former HOP Outreach Worker 1996-97Presently: Family Care Physician in Portland, Oregon
An Outreach Workers Perspective
◦Be prepared.
◦Be persistent.
◦You are the real deal!!
Implementing the ACA
Oscar C Gomez– [email protected]
Health Outreach Partnerswww.outreach-partners.org
Q&A: Making Sense of the ACA
Please tell us: your name where you’re from your organization
Thank You!
For more information:
Phil [email protected]
Merrill [email protected]
www.pwjohnston.com
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