Outreach and Enrollment Lauren Seno Project Specialist lseno@wphca.org 608-443-2955
Focus for Today Explore the health care environment following the second open enrollment period and external pressures impacting the work we do. Learn more about the role of health centers in outreach and enrollment work.
Outline Affordable Care Act Crash Course Enrollment in Wisconsin Outreach & Enrollment at WI FQHCs Future of Enrollment
Jeopardy! Full Patient Name of Protection Obamacare and Affordable Care Act Age Limit for Staying on FPL Range that Qualifies for Parental Insurance 26 Subsidies 100-400% Date Obamacare Was Signed March Into Law 23, 2010 (5 Years Old!) Number of Essential Health Benefits 10 Maximum GREATER Penalty in of: 2014 for not having 285$ insurance or 1% of annual income
Affordable Care Act Act Prevent insurers from denying coverage to those with pre-existing conditions Require everyone* in the US to have health insurance Individual Mandate Offer subsidies to make insurance affordable * unless you qualify for an exemption
Exemptions Exemptions: link to complete listing Lowest-priced coverage available to you was > 8% household income Hardship (homeless, victim of domestic violence, filed for bankruptcy, etc.) Religious objection or part of health care sharing ministry Eligible for Indian Health Services Live in a state that did not expand Medicaid and your income is <100%FPL Image Source
Image Source Shared Responsibility Payment Penalty Fine assessed on your annual taxes if you do not have qualifying coverage
Health Insurance Marketplace Exchange or FFM Federally Facilitated Marketplace Online search and application tool for health insurance products Can apply by phone or use paper application Eligibility Determination Almost anyone can purchase a QHP through the Marketplace Subsidies (offset the cost) are only available to those who qualify Open Enrollment Dates November 1 st, 2015 January 31 st, 2016 Special Enrollment Periods (SEPs) Medal tiers: Bronze, Silver, Gold and Platinum with ascending premiums, benefits and cost-sharing
General Subsidy Eligibility Criteria Not available to those who are offered affordable insurance through their job not affordable if monthly premium is > 9.56% family income Not available to those who qualify for government-sponsored insurance (Medicaid, Medicare, etc.) Eligible if: US Citizen or lawfully present immigrant Income is between 100-400% FPL Lawfully present immigrants in their 5 year waiting period below 100% FPL If legally married must file jointly
Subsidy Calculation Once the consumer s income is determined (some types of income don t count) the expected contribution is based on the second-lowest cost silver plan Image Source
National Challenges Supreme Court King vs. Burwell: Challenge to the subsidies offered through FFM The House had voted 56 times in 4 years to repeal the ACA Misperceptions of the law 60% of Americans say they don t understand how the ACA specifically impacts them (Source) Image Source
National Numbers In 2014: ~ 8 million people signed up for Marketplace QHPs In 2015: ~ 11.4 million people signed up/re-enrolled in Marketplace QHPs Wisconsin Numbers Image Source 207, 359 enrollees in Marketplace QHPs 90% received financial assistance (subsidies) Average Monthly Premium: 125$ ~78% average reduction in monthly premium cost
What s happening in Wisconsin? Environmental: Medicaid Changes Regional Enrollment Networks Certified Application Counselors at FQHCs Past, present and future!
BadgerCare+ Eligibility Changes January 1, 2014 Image Source
Regional Enrollment Networks 11 Regional Enrollment Networks REN Coordinators DHS Support REN Activities: Stage community enrollment events Leverage local resources Super Saturday Coordinated Statewide Event EnrollWI.org Consumer Calendar Update Emails Weekly During Open Enrollment Stakeholder engagement Strategic Planning Committee Image Source
Certified Application Counselors at CHCs Certified Application Counselor (CAC) Functionally the same as a Navigator NOT agents/brokers One time funding to CHCs to train and hire enrollment staff/cacs Rolled into base-funding Continued expectation from HRSA to have CACs on staff
Health Center CACs By the Numbers As of 2/2/2015: 110 Trained CACs at Health Centers in Wisconsin 17,067 Application Assists 3,345 Applications Submitted
Future of Health Center CACs Challenges: Marketplace QHPs not contracting with Community Health Centers signing consumers up for coverage may mean they have to go elsewhere for care Restrictions on CACs ability to market CHC services while doing enrollment work Staffing: outside of Open Enrollment
Future of Health Center CACs Opportunities: Incorporating the CACs into patient resource staff Consider the whole lifecycle of a patient (from coverage to care) Focus on health literacy Break down the enrollment staff silo
Patient Engagement Meaningful Use: Patient Portal Requirement making online access to medical information available to 50% of patients 5% using to send secure messaging Drive success when patients can see portals in waiting rooms Repurpose CAC staff outside of open enrollment to address Portal Requirement Coordination of Benefits Lots of Health Center patients may also benefit from other enabling services (FoodShare, etc.) cross functional enrollment staff Focus on patient lifecycle, not just insurance