REQUEST FOR PROPOSALS (RFP) National Center for Benefits Outreach and Enrollment

Benefits Enrollment Center Grants Released November 10, 2008

Purpose

The National Center for Benefits Outreach and Enrollment (the Center) at the National Council on Aging (NCOA) will provide 10 grants of up to $100,000 each to local or state organizations for the implementation of coordinated Benefits Enrollment Centers (BECs) that use person-centered strategies in a coordinated, community-wide system to find and enroll both seniors and younger beneficiaries with disabilities who have limited income and resources in available benefits—with the primary focus being on the following benefits programs:

• Medicare Part D Extra Help (or Low Income Subsidy, LIS) • Medicare Savings Programs (MSP) • Medicaid • Supplemental Nutrition Assistance Program (SNAP was formerly the federal

Food Stamp program) • State Pharmacy Assistance Programs (SPAPs, where applicable) • Low-Income Home Energy Assistance (LIHEAP)

Grantees also have the option of including other benefits in their proposal, such as:

• Supplemental Security Income (SSI). Grantees may choose to include SSI as part of the pool of benefits in which they will seek to enroll consumers.

• Other benefit programs included by applicant, including but not limited to state property tax relief, state tax credits and other programs.

Goal This grant program seeks to develop and foster community-based, person-centered systems for finding and enrolling both seniors and younger adults with disabilities who have limited income and resources—in available need-based public benefits, with the ultimate goal of making these enrollment processes as seamless as possible for consumers and their families. A “person-centered” approach is one in which someone is screened and applies for multiple benefits at one time.

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Background About the Center Funded by the U.S. Department of Health and Human Services Administration on Aging in September 2008, the National Center for Benefits Outreach and Enrollment (the Center) will:

• fund and establish Benefits Enrollment Centers (BECs) in 10 areas of the country;

• foster the use of cost-effective benefits outreach and enrollment strategies by BECs and others in the aging and disability services provider networks to find and enroll people with limited means in public benefits;

• increase the use of web-based decision support, screening and enrollment tools among the aging and disability services networks, consumers, families and caregivers;

• maintain, update, and enhance the usability of current benefits screening and enrollment systems;

• provide training and technical assistance to BECs and to the larger aging and disability networks regarding cost-effective, promising practices and other topics related to benefits outreach and enrollment; and,

• develop an online information clearinghouse on promising practices related to benefits outreach and enrollment.

More information about the Center can be found at www.CenterforBenefits.org. About NCOA Founded in 1950, NCOA has a mission to improve the lives of older Americans. A non-profit organization with 3,200 members, we also have a national network of some 14,000 organizations and leaders that help us in our work. NCOA members include senior centers, area agencies on aging, adult day service centers, faith-based service organizations, senior housing facilities, employment services, consumer groups and leaders from academia, business and labor. Our programs help older people remain healthy and independent, find jobs, increase access to benefits programs, and discover meaningful ways to continue contributing to society. To learn more about NCOA, please visit www.ncoa.org.

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The Benefits Access Group within NCOA is committed to helping eligible people to enroll in all the need-based programs for which they qualify. Over the last several years we have led two nation-wide campaigns dedicated to providing assistance to Medicare beneficiaries:

• The Access to Benefits Coalition (ABC)1 is a coalition of over 100 national organizations and hundreds of local nonprofit organizations that share a commitment to helping Medicare beneficiaries with lower incomes and resources find the public and private prescription savings programs they need to maintain their health and improve the quality of their lives. ABC includes hundreds of local, community-based nonprofit organizations in 43 communities in 34 states and the District of Columbia.

• My Medicare Matters2 is a community-based education program that is helping thousands of people with Medicare learn about the Medicare Prescription Drug Coverage (Part D) and make the enrollment decision that is right for their personal health and financial situation.

In addition, in 2001, NCOA launched BenefitsCheckUp® (BCU), a free, comprehensive online benefits screening and enrollment tool. To date, more than 2 million people have used BenefitsCheckUp® to find out if they are likely eligible for more than $6 billion in public and private benefits. Over the past two years, BenefitsCheckUp® has worked closely with the Social Security Administration (SSA) to develop a Live Online LIS Application Tool. The online tool consists of a user-friendly application that allows consumers and organizations, working one-on-one with clients, to submit live LIS enrollments directly to SSA. Additionally, upon completing the online application, users receive a “Shadow Screening Report” of their eligibility for other key benefits programs such as MSPs, Medicaid, and SPAPs. To learn more about BCU, please visit: www.BenefitsCheckUp.org. The problem Millions of seniors and younger adults with disabilities who have limited incomes and resources qualify for, but are not yet enrolled in programs that help pay for prescription drugs, medical care, food or heat for their homes. Even decades after their inception, public benefits programs are remarkably undersubscribed. Estimates show that somewhere between 1.8 and 3 million Medicare beneficiaries are eligible for, but not receiving, the Medicare Part D Extra Help/LIS.3 The enrollment rate in one of the MSPs is only 13 percent, and only 30 percent of eligible seniors participate in the

1 www.AccesstoBenefits.org 2 www.MyMedicareMatters.org 3 Estimates differ based on source of data. The most recent CMS estimates indicate that about 1.8 million remain

(http://www.cms.hhs.gov/Partnerships/Toolkits/itemdetail.asp?filterType=none&filterByDID=-99&sortByDID=1&sortOrder=ascending&itemID=CMS1188820&intNumPerPage=10); however, this estimate does not include the number of people already enrolled in Part D plans who are eligible, but not yet enrolled in LIS. Kaiser Family Foundation estimates suggest closer to 3 million. (Kaiser Family Foundation. Low-Income Assistance Under the Medicare Drug Benefit. Kaiser Family Foundation: Washington, DC, February 2008.)

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Supplemental Nutrition Assistance Program (SNAP was formerly the federal Food Stamp program). The federal government has invested in outreach campaigns for various benefits programs over many years, but there are limits to the reach of Federal agency efforts. Most federal agencies are limited by statute and/or practice from conducting outreach for programs other than their own. For example, the U.S. Department of Agriculture (USDA) conducts SNAP/Food Stamp outreach; SSA conducts LIS and SSI outreach; the Centers for Medicare & Medicaid Services (CMS) conducts Medicare Part D outreach. There are efforts at the Federal level to do outreach to one person and enroll them in as many programs for which they are eligible at one time. For example, the Aging and Disability Resource Centers (ADRCs) are working to streamline access to publicly funded benefits. Many States provide a SNAP program application that can be used to apply for multiple programs at the same time. But most agencies do outreach exclusively for their own programs. People who are eligible for one means-tested public benefit are highly likely to also be eligible for, but not receiving other key public benefits. According to an analysis of BenefitsCheckUp® screening data, the percent of LIS-eligible people also likely to be eligible for other benefits are as follows: 57 percent MSPs, 46 percent SPAPs, 37 percent SNAP/Food Stamps, 25 percent Medicaid programs, and 14 percent SSI. A person-centered approach takes the total needs and circumstances of a person into account, not just their need for a particular benefit, and involves not only informing people of their benefits eligibility, but also helping them navigate the application process. It is both more seamless for the consumer and more efficient with regards to state and federal spending. In 2005, NCOA undertook a major benchmarking study examining more than 30 different single-benefit outreach and enrollment projects for the LIS. This study showed that, consistently, about 55 percent of the total costs per enrollment are related to identifying qualified people and persuading them to apply and 45 percent of the costs relate to actual assistance with applications.4 Research also has continued to show that community-based organizations, using a one-on-one person centered approach, are the most effective at finding potential eligibles for need-based programs. A new challenge and opportunity for growth in the area of benefits enrollment is in the use of online technology to learn about and apply for benefits. Currently, SSA reports that about 24 percent of LIS applications are received electronically, still a minority of its LIS application submissions, but a sizable increase in online submissions from previous years.5 Getting available technology in the hands of community organizations and consumers – including the technology itself customized to meet the need of its users, and the training needed to run the technology effectively – has the potential to result in significantly increased enrollment.

4 http://www.accesstobenefits.org/library/pdf/PathwaysToSuccess.pdf5 Statement of Bea Disman, Chair of the SSA Medicare Planning and Implementation Taskforce, at the

LIS Advocates meeting in March 2008.

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The program The Center has allocated up to a total of $1,000,000 to fund 10 grants of up to $100,000 each to state and/or community-based organizations with the goal of maximizing enrollment of seniors and adults with disabilities who have limited incomes and resources, into need-based public benefits. The target populations for these grants are both seniors and younger adults with disabilities, and their families. The expected duration of the projects funded under this initiative is 12 months (March 1, 2009 to February 28, 2010). Total grant funding for each accepted project is expected to be up to $100,000. All grantees are expected to use a person-centered approach to find and enroll seniors and younger people with disabilities, in all the need-based public benefits for which they may be eligible. The primary focus will be on the following benefits programs:

• Medicare Part D Extra Help (LIS) • Medicare Savings Programs (MSP) • Medicaid • Supplemental Nutrition Assistance Program (SNAP was formerly the federal

Food Stamp program) • State Pharmacy Assistance Programs (SPAPs, where applicable) • Low-Income Home Energy Assistance (LIHEAP)

Grantees also have the option of including other benefits in their proposal, such as:

• Supplemental Security Income (SSI). Grantees may choose to include SSI as part of the pool of benefits in which they will seek to enroll consumers.

• Other benefit programs included by applicant, including but not limited to state property tax relief, state tax credits and other programs.

Coordinated Community Approach The purpose of these grants is to develop and implement coordinated, community-wide, person-centered systems for finding and enrolling seniors and/or adults with disabilities in all the public benefits for which they are eligible. An integral part of this process will be community-mapping – determining the right partners who need to be engaged, figuring out the appropriate roles and commitment levels for each of the partners, and working together to determine which outreach and enrollment strategies will best fit the community being served. The ultimate aim is to create a community (or state-) based, person-centered benefits enrollment system that is as seamless as possible for consumers and their families and that is sustainable beyond the period funded by this grant.

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Applicants should employ the approach (or combination of approaches) that will enable them to be most effective and cost-efficient within the communities that they serve, and to use best practices within their chosen approach(es). Applicants should describe their approaches to finding eligible persons. Since 2005, NCOA has issued two reports which can aid applicants as they select the approaches they think will work best for the communities they are serving:

• Pathways to Success: Meeting the Challenge of Enrolling Medicare Beneficiaries with Limited Incomes (available at http://www.accesstobenefits.org/library/pdf/PathwaysToSuccess.pdf)

• Community Solutions: Lessons Learned from the My Medicare Matters Low-

Income Subsidy Demonstration Program (available at https://www.ncoa.org/Downloads/MyMedicareMatters%5FLessonsLearned08%2Epdf)

Both reports discuss model approaches to outreach and enrollment used by successful organizations and coalitions across the country—those able to find and enroll large numbers of beneficiaries with limited incomes at a reasonable cost. They also detail best practices within these approaches, which can help to drive costs per beneficiary down and enable organizations to be more efficient. Outreach, Education and Enrollment The Center recognizes that there are complementary activities needed to achieve the ultimate goal of maximizing the number of seniors and adults with disabilities with limited means who enroll in public benefits. However, the primary focus of this grant is on assisting people with submitting applications for benefits programs. Applications that focus solely on outreach and/or education will not be considered. Eligibility and selection criteria Likely grantees under this program include, but are not limited to, organizations listed below:

• nonprofit providers of services to seniors or adults with disabilities, including, but not limited to: Aging and Disability Resource Centers (ADRCs), Area Agencies on Aging (AAAs), State Health Insurance Assistance Programs (SHIPs), State Units on Aging (SUAs), Centers for Independent Living, community health centers, or senior centers;

• faith-based organizations and coalitions; • state and local government agencies serving older adults or persons with

disabilities; • consumer advocacy organizations or coalitions, especially organizations that

focus primarily on underserved populations such as African-Americans, Hispanics, Asian and Pacific Islanders, Native Americans, or adults with disabilities.

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All proposals must include a one-paragraph executive summary, a description of the applicant’s strategy, an implementation plan for the applicant’s outreach and enrollment activities, budget, and letters of commitment from intended partners. (Guidelines for drafting the project implementation plan are included in Attachment A.) In assessing the quality of each proposal submitted, the Center will consider:

• Commitment to assist a minimum of 1,000 people with filing applications for all need-based benefits programs on the target list for which they are likely eligible; applicants who can reasonably propose higher numbers are encouraged to do so;

• Demonstrated understanding of and commitment to need-based benefits outreach and enrollment;

• Proven access and credibility, especially with low-income audiences or, as appropriate, other audience segments (e.g., underserved populations);

• Plans for identifying likely eligible persons, for example community referrals, use of lists, etc.

• Evidence that the project is feasible given existing funding and regulatory constraints;

• Demonstrated commitment of intended partners; • Demonstrated understanding of the technical capacity and resources necessary

to carry out the project; • Commitment to use BenefitsCheckUp® (www.benefitscheckup.org) as the online

tool for screening and enrollment in benefits; or reporting results; • Commitment to participate in ongoing information-sharing with other grantees

and with national staff; • Commitment to participate in overall evaluation of the demonstration projects; • Plans for sustaining promising or successful activities after grant funding

concludes; • Commitment to match at least 15 percent of grant funding, either a cash or in-

kind match (for example, if applicant requests $100,000 from Center, the applicant must include an additional $15,000 of their own resources for a total budget of $115,000);

• Applicants are encouraged to leverage other resources to increase the number of people served.

The Center reserves the right to conduct pre-decision site visits or conference calls as part of the proposal evaluation process. Each application will be scored to a total of 100 points. Please see Attachment A for required elements of the RFP Implementation Plan. Each section of the application will be allocated a maximum potential number of points. These scores will provide a primary, but not exclusive basis for determining final approval. The Center reserves the right to approve grantees based on a composite of factors.

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• Background on current system/justification [10 points] • Plan Objectives and Timeline [15 points] • Target Area and Populations [10 points] • Coordinated Community-wide Approach [35 points] • Management and Organization [15 points] • Budget [15 points]

Program direction and technical assistance resources The Center will provide overall direction for the grants program and technical assistance to the participating sites. Center staff will provide technical assistance, training and tools to grantees to assist them in maximizing enrollment in needed benefits. Grantees will be expected to:

• submit programmatic and financial reports in a timely manner; • use BenefitsCheckUp® (www.BenefitsCheckUp.org) for screening and enrolling

clients in benefits, as appropriate; • participate in regular conference calls and web surveys; • attend in-person meetings/conferences as needed (with funding to be included

as part of each applicant’s grant budget); • share information and “lessons learned” with fellow grantees and Center staff;

and • participate in an overall evaluation of the grant program.

Use of grant funds All funds provided to successful applicants under this grant program are federal funds from the U.S. Department of Health and Human Services Administration on Aging. As such, all current federal rules apply and must be adhered to. As a condition of accepting grant funds, grantees must meet Center requirements for the submission of programmatic and narrative reports. Project/program directors also may be asked to attend periodic meetings and to give progress reports on their projects. Reporting requirements Grantees will be required to provide monthly Web-based reports of outreach and enrollment figures, including numbers of people enrolled in benefits. (Format will be provided to grantees after grant award.) In addition, grantees will be asked to participate in periodic conference calls, respond to periodic emails and Web-based surveys aimed at gathering information, e.g. case studies and best practices that will be helpful to other

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organizations in their outreach and enrollment efforts. Finally, grantees will be required to participate in an overall evaluation of the grant program. How to apply 1. Letter of Intent. Organizations wishing to apply for funds under this program

should send an email to the Center indicating their intent to apply for one of the Benefits Enrollment Center grants by Monday, November 24, 2008 (contact information below). This email which is for Center planning purposes only is non-binding and does not need to describe the proposed project. It should simply list the name and contact information of the organization and indicate that they intend to apply for one of the grants.

2. Application. Applicants must submit a proposal describing the proposed project

and the applicant, with background relevant to the issues outlined in these guidelines. This proposal must include:

• a one-paragraph executive summary; • a description of the strategy to be employed; • an implementation plan for the applicant’s outreach and enrollment

activities (see Attachment A); • a budget (see Attachment B); • the project director’s resume/vitae; and • letters of commitment from intended partners.

Proposals must be no more than 15 pages in length (single-spaced with 1-inch margins, using a font size of not less than 12-point). The letters of commitment, project director’s vitae, timeline, and budget are not counted in the page limitation. If proposals are submitted in excess of 15 pages in length, we will not read anything past the 15th page. All proposals must be submitted electronically as a Microsoft Word or PDF attachment no later than Monday, December 22, 2008 by 5 pm Eastern time.

Please email letters of intent and proposals to: CenterforBenefits@ncoa.org Applicants will receive acknowledgement via email from the Center of receipt of both the letter of intent and the proposal. Applications will be reviewed by a panel of national experts. Applicants selected to receive grants will be notified by early to mid-February 2009.

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Inquiries All inquiries regarding this demonstration program should be emailed to: CenterforBenefits@ncoa.org. In addition, there will be two conference calls/webinars for potential applicants. These sessions will be held on Monday, November 17, 2008 from 1-2 pm Eastern and Thursday, November 20, 2008 from 3-4 Eastern. The conference call number is 1-866-740-1260 and the passcode is 4796639#. The web portion of the session may be viewed at www.ReadyTalk.com (4796639). These calls are for informational purposes only; they are intended to answer questions applicants may have when writing their proposals. Participation in these calls is not a condition for funding. Timeline Monday, November 10, 2008: RFP is released Monday, November 17, 2008: First applicant conference call/webinar, 1:00-2:00 pm

EST Conference call number: 1-866-740-1260, passcode 4796639#

Web: www.readytalk.com (code:4796639 ) Thursday, November 20, 2008: Second applicant conference call/webinar, 3:00-4:00

pm EST Conference call number: 1-866-740-1260, passcode: 4796639#

Web: www.readytalk.com (code: 4796639 ) Monday, November 24, 2008: Deadline for submission of email indicating intent to

apply for National Center for Benefits Outreach and Enrollment—Benefits Enrollment Center Grants

Monday, December 22, 2008 5 pm Eastern time: Deadline for submission of grant

proposals Early to mid-February 2009: Notification of applicants selected to receive grants Attachments Attachment A: Guidelines for Implementation Plan Attachment B: Required budget format

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Attachment A

Specifications for Project Implementation Plan for the National Center for Benefits Outreach and Enrollment—Benefits Enrollment Center Grant Applications Targeted benefits program list: Medicare Part D Extra Help (LIS); Medicare Savings Programs (MSP); Medicaid; Supplemental Nutrition Assistance Program (SNAP was formerly the federal Food Stamp program); State Pharmacy Assistance Programs (where applicable); Low-Income Home Energy Assistance (LIHEAP); Optional: Supplemental Security Income (SSI).Grantees may choose to include SSI as part of the pool of benefits in which they will seek to enroll consumers; Optional: Other benefit programs included by applicant. 1. Applicant information:

Organization Name Project Director Street Address City/State /Zip Telephone Fax E-mail Website (if available)

2. Plan Timeframe

March 1, 2009-February 28, 2010 3. Background and justification on current benefits outreach enrollment system [10

points] a. Describe the current benefits outreach and enrollment system in your proposed

target area. b. Provide justification for why your proposed outreach area needs a Benefits

Enrollment Center. c. Provide an explanation of how a Benefits Enrollment Center would make an

important contribution to the benefits outreach and enrollment system as it currently stands (both for consumers and technologically) in your proposed target area.

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4. Plan Objectives and Timeline [15 points] Identify objectives for the grant period. Include measurable goals for the following:

a. Number of people to be educated about the need-based benefits programs on the target list.

b. Number of people to be screened for benefits on target list. c. Expected number of people enrolled in the benefits on the targeted list.

Note: When we refer to enrollment, we mean applications completed and submitted to the appropriate agency.

d. Expected number of people enrolled in any optional benefits selected. Note: When we refer to enrollment, we mean applications completed and submitted to the appropriate agency.

e. Provide timeline by task with milestones. (The timeline does not count towards the 15 page limit.)

5. Target Area and Populations [10 points]

a. Identify the specific geographic area(s) your proposed project will serve – a city, county (or multiple counties), or your entire state.

b. Identify your general target population within that service area, as well as any specific underserved populations (e.g., minority communities, younger Medicare beneficiaries with disabilities, people who are homebound, people with limited English proficiency, people in rural areas) whom you will serve.

c. Describe your organization’s experience with reaching out to this target population for benefits enrollment work.

6. Coordinated Community-wide approach [35 points]

a. Identify the approach (or combination of approaches) your organization and any potential partners will use to find and enroll seniors and younger persons with disabilities who have limited income and resources in the programs included in the targeted list. Describe why you think this approach (or these approaches) are best suited to the community that you will serve and how they improve upon the current system in place.

b. Describe how you will put this approach (or approaches) into action in the geographic area covered under this application.

c. Describe how you will coordinate your outreach and enrollment efforts with other relevant agencies in your community/state. Identify any partner organizations that will assist you with finding and enrolling seniors and younger persons with disabilities who have limited incomes and resources in the need-based programs on the targeted list. Indicate the specific roles that these partners will play in your project. For example, will they serve as an enrollment center (phone-based and/or in-person)? Will they supply client lists for list-driven strategies? Will they focus on outreach to specific populations? Will they work on media outreach? Will they provide translation services? Will they develop educational materials? This role should be reflected in the letter of commitment that this partner organization provides.

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7. Management and Organizational Capacity [15 points] a. Identify Project Director, describe relevant experience, identify time

commitment to this project. b. Identify other key staff relevant experience and time commitment. c. Discuss the use of volunteers and how those volunteers will be managed. d. Explain how this project fits with your organization’s mission and other

programs. e. Describe your organization’s track record related to finding and enrolling people

with both seniors and younger beneficiaries with disabilities who have limited income and resources—in need-based benefits programs, including relevant recent activities related to the work outlined in this plan.

f. Letters of commitment from partner organizations.

8. Budget [15 points] a. Complete spreadsheet on budget (Attachment B), with separate page(s) for

narrative justification.

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Attachment B Provide detailed budget information below, with a separate page(s) for narrative justification. Please budget for one two-day in person meeting in Washington, DC. Note: Each applicant determines the allocation of the 15% match requirement (cash or in-kind) in the budget spreadsheet below. Please reflect your proposed match in the appropriate column below.

BUDGET National Center for Benefits Outreach and Enrollment—Benefits

Enrollment Center Grants Organization Name Project Director Fiscal Director Fiscal Director Phone Number Total Grant Amount Requested Grant Period (start to end) March 1, 2009 through February 28, 2010 Date submitted

Item PROPOSED BUDGET

AMOUNT APPLICANT 15% MATCH TOTAL

PERSONNEL Fringe Benefits

Personnel Subtotal $ - OTHER DIRECT COSTS Travel (within the target area) Travel to required meetings/conferences Printing/Duplication Supplies Telephone Postage Advertising Equipment Consultants Contracts

Other Direct Subtotal $ - OVERHEAD COSTS Grand Total $ -

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