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Getting Ready for the Expansion of Coverage in

2014Presentation for Texas CHIP Coalition

June 15th, 2012

Ani Fete, Director of State AssistanceMartine Apodaca, Director of Public Education

www.Enroll America.org

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Goals for Today’s Presentation

1. Learn about Enroll America and how we hope to support state enrollment efforts.

2. Understand the policy options Enroll America promotes to simplify and streamline enrollment.

3. Discuss outreach planning needs in Texas and identify at least one step your state can take this year to get ready.

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About Enroll America

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

Mission: ensure that all Americans get enrolled – and stay enrolled – in health coverage.

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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 advertising campaign;

2. Supplement and enhance state-based public education and outreach work;

3. Create national and state partnerships to amplify enrollment messages; and

4. Recruit, train and utilize corporate and celebrity partners.

How Do We Get There?

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.)

Enroll America will hire a firm to conduct extensive market and consumer research.

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 SYSTEMS will need to be developed to make it possible?• 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

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

How can people KEEP coverage once they’ve got it?• Data-driven renewal• No need to return forms• Opportunities to update

information and change coverage as circumstances change

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Health Coverage in 2014

Medicaid Exchange with Tax Credits

Exchange or Private Plan

Income as a percent of the federal poverty level

0 133 400+

Coverage Options for Adults without Medicare or Employer-Based Coverage

A Continuum of Coverage – Everyone Fits Somewhere!

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The 2014 Enrollment Challenge

Series10

5

10

15

20

Source: March 2012 CBO estimates

Mill

ions

Enroll at least 21 million people in new coverage options

}8 million in Exchange coverage

13 million in Medicaid or CHIP}

The Enrollment Challenge in Texas

• 6.1 million non-elderly uninsured

• Over half likely Medicaid eligible (54 %)

• 38% eligible for exchange coverage with premium tax credit

• 8% eligible for exchange w/out tax credit

Source: March 2010 and 2011 Current Population Survey

Non-elderly uninsured

0

1000000

2000000

3000000

4000000

5000000

6000000

7000000

3,314,000

2,341,500

477,900

400% FPL and upBetween 138-400% FPL<138% FPL

Data-driven Renewal for Continuous Coverage

Online Tool for Consumers to Easily Compare and Enroll in Health Plans

Modern, Data-driven Verification Systems

“No Wrong Door” Eligibility and Enrollment Model

Simple, Streamlined Application

A New Way to Enroll in Coverage

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Single, Streamlined ApplicationNow• Different applications for

different programs• Denied? Back to the

drawing board• Applications often only

available on paper or as PDFs if online

• In-person interview requirements

2014• Regulations require a single

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

UX 2014 – Model ApplicationBehavioral segmentation to design a system that is responsive to people’s different needs, desires, and expectations.

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“No Wrong Door”Consumers can connect to whichever program they are eligible

for, no matter where they start.Complete single

application Determine eligibilityEnrolled in correct

program!

Medicaid

CHIP

Exchange

Medicaid

CHIP

Exchange

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 CHIPNow• Renew every few months• Submit new paperwork to

prove eligibility• Pre-populated forms,

passive renewal in some states, mostly for kids

2014• Redetermine every 12 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• N/A

2014• 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

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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. Take advantage of federal funding.2. Develop an outreach plan.3. Automate enrollment for early gains.4. Minimize documentation requirements.5. Promote data-driven eligibility systems.6. Redouble efforts on consumer assistance.7. Make materials easy to read and understand.

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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 FundingMedicaid 90/10 match

Alaska: Applied to use 90/10Hawaii: Using 90/10

Source: Performing Under Pressure: Annual Findings of A 50-State Survey of Eligibility, Enrollment, Renewal, and Cost-Sharing Policies in Medicaid and CHIP, 2011-2012, Kaiser Family Foundation, January 2012.

Key

Using 90/10

Applied to use 90/10

Plan to apply this year

Not using/no plans

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Federal FundingExchange Establishment Grants as of May 15, 2012

Alaska: NoHawaii: Yes

Key No grant

One Level I grant received

Multiple Level I grants

Level II grant received

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Collaboration: A Key to Success

• Sharing Resources• Sharing Information• Planning Together

Whether it’s policy implementation or outreach planning, both are most successfully driven by collaboration across government, nonprofit, and corporate sectors.

State Assistance

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• 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.

Sharing from Other States

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• 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

Discussion

Thank you!

Martine ApodacaDirector, Public Education

MartineA@enrollamerica.org

Ani FeteDirector, State AssistanceAniF@enrollamerica.org

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