Post on 14-Dec-2015
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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