Getting Ready for the
Expansion of Coverage in
2014
Presentation for Texas CHIP Coalition
June 15th, 2012
Ani Fete, Director of State Assistance
Martine Apodaca, Director of Public Education
www.Enroll America.org
1
Goals for Today’s Presentation
1. Learn about Enroll America and how we
2.
3.
hope to support state enrollment efforts.
Understand the policy options Enroll
America promotes to simplify and
streamline enrollment.
Discuss outreach planning needs in Texas
and identify at least one step your state
can take this year to get ready.
2
About Enroll America
Mission: ensure that all Americans get enrolled – and stay
enrolled – in health coverage.
Diverse Partners:
• Consumer groups
• Insurance companies and
health plans
• Hospitals and community
health centers
• Providers
• The Rx industry
• Civic organizations
• Organizations representing
communities of color
• Many more
Two-fold strategy:
• Promoting Best Practices
• Raising Public Awareness
3
Raising Public Awareness
2013: We will launch a national public education campaign to
inform Americans about the benefits of health coverage and
their rights and obligations under the Affordable Care Act
(ACA). The goals of this campaign will be:
1. Develop a sophisticated national data and research-driven
2.
3.
4.
advertising campaign;
Supplement and enhance state-based public education and
outreach work;
Create national and state partnerships to amplify enrollment
messages; and
Recruit, train and utilize corporate and celebrity partners.
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How Do We Get There?
Enroll America will hire a firm to conduct extensive
market and consumer research.
We specifically want to know: (1) what
are the most effective messages to
reach different demographic and
geographic groups; (2) who are the
best messengers for these
communications and (3) what are the
best means of reaching the groups (e.g.
television, radio, social media, etc.)
How will people APPLY for
coverage?
•
•
•
•
Online? By phone? On paper?
Available in the right languages?
Written in plain language?
Accessible for people with
disabilities?
What ASSISTANCE will they
need?
• Understanding the application and
eligibility process
• Counseling on tax credit decisions
• Help choosing a plan and learning
how to use it
What SYSTEMS will need to be
developed to make it possible?
How can people KEEP coverage
once they’ve got it?
• Consumer-friendly “front end”
• “Back end” systems that are
coordinated between Medicaid, the
Exchange, CHIP, other programs
• Connections with data that can help
prove eligibility
• Data-driven renewal
• No need to return forms
• Opportunities to update
information and change coverage
as circumstances change
Health Coverage in 2014
Coverage Options for Adults without Medicare
or Employer-Based Coverage
Income as a percent of the federal poverty level
0
133
400+
A Continuum of Coverage – Everyone Fits Somewhere!
7
The 2014 Enrollment Challenge
Enroll at least 21 million people in new coverage options
20
Millions
15
}
8 million in Exchange coverage
}
13 million in Medicaid or CHIP
10
5
0
Source: March 2012 CBO estimates
8
The Enrollment Challenge in Texas
• 6.1 million non-elderly
7000
uninsured
• Over half likely
Medicaid eligible (54 %)
• 38% eligible for
exchange coverage with
premium tax credit
• 8% eligible for exchange
w/out tax credit
6000
478
5000
Thousands
2,342
400% FPL
and up
4000
Between
138-400%
FPL
3000
2000
3,314
<138% FPL
1000
0
Non-elderly
uninsured
Source: March 2010 and 2011 Current Population Survey
A New Way to Enroll in Coverage
Simple, Streamlined Application
“No Wrong Door” Eligibility and Enrollment Model
Modern, Data-driven Verification Systems
Online Tool for Consumers to Easily Compare and Enroll in Health Plans
Data-driven Renewal for Continuous Coverage
Single, Streamlined Application
Now
2014
• Different applications for
• Regulations require a single
•
•
•
different programs
Denied? Back to the
drawing board
Applications often only
available on paper or as
PDFs if online
In-person interview
requirements
•
•
application as gateway to all
coverage programs
Must be available online, by
telephone through a call
center, by mail, and in
person
Interview requirements
prohibited
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UX 2014 – Model Application
Behavioral segmentation to design a system that is responsive to
people’s different needs, desires, and expectations.
“No Wrong Door”
Consumers can connect to whichever program they are eligible
for, no matter where they start.
Complete single
application
Enrolled in correct
program!
Determine eligibility
Exchange
Exchange
Medicaid
Medicaid
CHIP
CHIP
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Data-driven Verification System
Now
• Assumed ineligible until
•
•
proven otherwise
Onerous paper
documentation burden: pay
stubs, birth certificate,
proof of residency, etc.
Asset tests common
2014
• Real-time, electronic
verification to the greatest
extent possible
• Must use federal electronic
service (“data hub”)
• Reasonable Compatibility
standard
• Attestation allowed for most
elements
• Paper documentation
requirements prohibited if data
available electronically
• Asset tests not permitted
Renewals – Medicaid and CHIP
Now
2014
• Renew every few months
• Submit new paperwork to
• Redetermine every 12
•
prove eligibility
Pre-populated forms,
passive renewal in some
states, mostly for kids
•
•
•
months
Data-driven, without
requiring applicant to sign or
return a form, if possible
If not possible, send enrollee
pre-populated form and
allow 30 days to return
Enrollees must report
changes that could affect
eligibility
Renewals - Exchange
Now
2014
• N/A
• Exchange sends annual
•
•
•
redetermination notice with
projected eligibility for coming
year
Enrollee has 30 days to report
changes
If notice is not returned,
exchange makes
redetermination based on their
projection
Enrollees must report changes
that could affect eligibility
But open enrollment doesn’t
start until October 1, 2013...
What can be done
right now to
promote
enrollment?
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7 Concrete Steps for 2012
1.
2.
3.
4.
5.
6.
7.
Take advantage of federal funding.
Develop an outreach plan.
Automate enrollment for early gains.
Minimize documentation requirements.
Promote data-driven eligibility systems.
Redouble efforts on consumer assistance.
Make materials easy to read and understand.
19
Sources of Federal Funding
Medicaid 90/10
• Eligibility and claims
systems upgrades
• Must meet 7 criteria,
including seamless
coordination with an
exchange
• Available through 12/15
• 75% match for
operations and
maintenance
Exchange Establishment
Grants
• Activities related to
creating an exchange (11
core areas, including
stakeholder consultation,
program integration,
Exchange IT systems,
providing assistance to
individuals and small
businesses)
• Available through 1/1/15
• Level I and Level II
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Federal Funding
Medicaid 90/10 match
Key
Using 90/10
Alaska: Applied to use 90/10
Hawaii: Using 90/10
Applied to use 90/10
Plan to apply this year
Not using/no plans
Source: Performing Under Pressure: Annual Findings of A 50-State Survey of Eligibility, Enrollment, Renewal, and Cost21
Sharing Policies in Medicaid and CHIP, 2011-2012, Kaiser Family Foundation, January 2012.
Federal Funding
Exchange Establishment Grants as of May 15, 2012
Key
No grant
Alaska: No
Hawaii: Yes
One Level I grant received
Multiple Level I grants
Level II grant received
22
Collaboration: A Key to Success
Whether it’s policy implementation or outreach planning, both are most
successfully driven by collaboration across government, nonprofit, and
corporate sectors.
• Sharing Resources
• Sharing Information
• Planning Together
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State Assistance
• Engaging national partners at the state level;
• Generate materials for state stakeholders to replicate and
•
•
•
•
•
use;
Share national public education campaign resources;
Outreach and enrollment assistance and toolbox;
Enhance communication and sharing within/between
states;
Coordinate approaches to funders;
Assist with organizing and providing support to state
collaborations for outreach, enrollment, and retention
initiatives.
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Sharing from Other States
• Building/Strengthening Coalitions
• Encouraging adoption of best
practices for enrollment and
retention at the state level
• Maintaining a website to enhance
communications with links to
enrollment channels
• Planning and implementing
outreach, enrollment, and retention
initiatives
25
Discussion
Thank you!
Martine Apodaca
Director, Public Education
MartineA@enrollamerica.org
Ani Fete
Director, State Assistance
AniF@enrollamerica.org
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