Affiliated Service
Providers of Indiana:
ASPIN Health Navigator
Program
IRHA’s Fall Forum: Harvesting Rural Solutions
November 14, 2013
“The mission of ASPIN is to provide innovative educational programs, resource management, program
development, and network management in collaboration with all healthcare entities to address health disparities.”
Today’s Presentation Goals
1. To introduce the Health Insurance
Marketplace
2. To describe ASPIN’s role in the Marketplace
3. To discuss the Marketplace in Rural Areas
4. To provide information on resources
available
Who is ASPIN?
• ASPIN, an Indiana based 501(C) 3 not for
profit behavioral health network that operates
five major service lines:
– Third Party Contract Administration,
– Professional Training,
– Grants Management,
– Consumer Education & Workforce Development,
(CRS Program)
– Technical Assistance
Grant Note:
The ASPIN Health Navigator Project was supported
by Funding Opportunity Number CA-NAV-13-001
from the U.S. Department of Health and Human
Services, Centers for Medicare & Medicaid Services.
The contents of oral, written, and electronic
communications are solely the responsibility of the
authors and do not necessarily represent the official
views of HHS or any of its agencies unless cited
otherwise.
Indiana’s Four
Federal Navigator Grant Recipients
1. Affiliated Service Providers of
Indiana
2. Plus One Enterprises, LTD, LLC.
3. Health and Hospital
Corporation of Marion County
4. United Way Worldwide (211)
Goals of ASPIN’s Project
• To outreach and educate individuals, families
and small businesses on Health Exchanges and
to facilitate selection and enrollment in
qualified health plans.
• To develop a navigator workforce consisting of
Veterans, Certified Recovery Specialists, and
Ivy Tech Community College students.
ASPIN Health Navigator Locations
Keys Facts Regarding Rural Coverage
• Nearly one in five uninsured
American lives in a rural area
• A greater number of rural residents lack health
insurance compared to urban residents
• Due to income levels, a large segment of the rural
population will be eligible for subsidized
insurance coverage through the marketplaces
Health Insurance Market Place
• A primary goal of the Affordable Care Act is to
help the 16 % uninsured and eligible
Americans gain access to quality, affordable
health care. Central to this goal is the Health
Insurance Marketplace.
• Indiana has a Federally-facilitated
Marketplace.
Key Dates
DATE
ACTIVITY
October 1, 2013
Start of Open
Enrollment. Plans and
prices will be available
Coverage starts for
enrolled individuals
January 1, 2014
March 31, 2014
Open Enrollment ends
Essential Health Benefits
•
•
•
•
•
Ambulatory patient services
Emergency services
Hospitalization
Maternity and newborn care
Mental health and substance use disorder
services
– Including behavioral health treatment (which
includes counseling and psychotherapy)
Essential Health Benefits
•
•
•
•
Prescription drugs
Rehabilitative services and devices
Laboratory services
Preventive and wellness services and chronic
disease management
• Pediatric services, including oral and vision
care
Who is Eligible?
• Individuals can buy insurance though the
Marketplace if they live in the United States, are
U.S. citizens or U. S. nationals (or are lawfully
present) and aren’t currently incarcerated.
• Nobody can be turned away or charged more
because of gender or a pre-existing condition.
• Depending on household income and family size,
many individuals may qualify for tax credits to
help lower their share of monthly premiums, or
help that reduces deductible, copayment or
other cost-sharing amounts.
Health Plan Categories
• Individuals will be able to choose a
Marketplace plan by health plan category
– Bronze
– Silver
– Gold
– Platinum, or
– Catastrophic
Indiana Market Place Health Plans
•
•
•
•
Physicians Health Plan (PHP)
Managed Health Services (MHS)
MDwise
Anthem Blue Cross
• 17 Regions
Rating
Area
Anthem
1
X
2
X
3
MHS
PHP
MDwise
X
X
X
X
X
X
X
X
X
4
X
X
X
X
5
X
X
X
6
X
X
X
7
X
X
X
8
X
X
X
9
X
10
X
X
X
11
X
X
X
12
X
X
13
X
X
14
X
15
X
X
16
X
X
17
X
X
X
What if a person chooses not to enroll
in a plan?
• Health care law requires all people who can afford it to take
responsibility for their own health insurance by getting
coverage or paying a penalty.
• If someone who can afford health insurance doesn’t have
coverage in 2014, they may have to pay a fee. They also
have to pay for all of their health care.
• The fee in 2014 is 1% of your yearly income or $95 per
person for the year, whichever is higher. The fee increases
every year. In 2016 it is 2.5% of income or $695 per person,
whichever is higher.
• In 2014 the fee for uninsured children is $47.50 per child.
The most a family would have to pay in 2014 is $285.
Health Plan Information
•
•
•
•
•
•
•
www.healthcare.gov/health-plan-information/
*12345
County - Johnson
Metal Level - Bronze
Insurance Issuer Name Plan Marketing Name – Bronze Direct Access
Plan Type – HMO
Health Plan Information cont.
• Rating Area – Rating Area 13
• Premium Amounts
– Adult age 27 $ 220.44
– Adult age 50 $375.67
– Family $744.62
– Single parent family $505.88
– Couple $537.62
– Child $133.57
You are cover if you have:
• Any Marketplace plan, or any individual insurance plan you
already have
• Any employer plan including COBRA (including retiree plans)
• Medicare
• Medicaid
• The Children’s Health Insurance Plan (CHIP)
• TRICARE (for current service members and military retirees, their
families, and survivors)
• Veterans health care programs (including the Veterans Health
Care Program, VA Civilian Health and Medical Program
(CHAMPVA), and Spina Bifida Health Care Benefits Program)
• Peace Corps Volunteer plans
Impact on States NOT Expanding
Medicaid
25 States and DC will Expand Medicaid
for 2014
Gaps in Coverage in States that Do Not
Expand Medicaid
Who Can Provide Help in Rural Areas?
• Certified Application Counselors
• Agents and Brokers
• Navigators
– Trained to provide unbiased information in
culturally competent manner
– Required to adhere to strict security and privacy
standards
– Certified annually through a training and testing
process
How can ASPIN Assist ?
• Take phone referrals and schedule enrollment
appointments at the ASPIN Health Navigator 800
number call center
• Schedule a navigator to
provide enrollment assistance
• Conduct outreach and education meetings in
your community
ASPIN’s Outreach Activites
• Consumers of behavioral health served by the
Community Mental Health Centers
• Students in Ivy Tech campuses, staff, friends,
and families
• Small businesses with less than 50 employees
not required to provide insurance for
employees
Outreach Workforce Targets
Create a workforce of 3 FTEs
and 30 part-time navigators
that consist of:
– Ivy Tech Community College Students
– Unemployed Veterans and Service
Members
– Certified Recovery SpecialistsPeer/Consumers
Outreach Contact Targets
Outreach
Population
Consumers of mental health
services
Community College students
Navigators at CMHCs
Navigators at Ivy
8,000
80,000
Tech campuses
Small Business/Groups
Total
All navigators
23,200
111,200
Outreach Strategies
• Onsite representation at college campuses and
community mental health centers
• Mobile office
• 20 hours per week
• Local events
• Outreach materials
• Opportunities to
contribute to
announcements/
communications
Call Center and Social Media
• Toll Free Number: 877- 313-7215
• Email: info@aspinhealthnavigator.org
• Website: www.aspinhealthnavigator.org
• Social Media Campaign
– Facebook page
– Twitter
Outreach to Small Businesses
• Identify businesses in local communities that
navigators will reach out to
• Appointments with
small business owners
who call in for assistance
• SHOP information posted
on the website
Additional Resources
• The Kaiser Family Foundation: Kaiser Family
Foundation - Health Policy Research, Analysis,
Polling, Facts, Data and Journalism
• KFF.org
– This website contains a wealth of information for
individuals and helps them understand how the
market place works, and allows them to estimate
their cost
Where can you find more information
about the Affordable Care Act
• State-by-state analysis
• http://www.hhs.gov/healthcare/facts/bystate/sta
tebystate.html
• Marketplace.cms.gov
• HealthCare.gov
• Health Insurance Marketplace Call Center:
• If you have questions, call 1-800-318-2596.
– TTY users should call 1-855-889-4325.
Contact Information
Kathy Cook, CEO
kcook@aspin.org
Julia Holloway, Project Director
jholloway@aspin.org
877- 313-7215
www.aspinhealthnavigator.org