Get Covered Tennessee A coordinated statewide initiative to help uninsured Tennesseans enroll in new health care coverage options Beth Uselton Program

Get Covered TennesseeA coordinated statewide initiative to help

uninsured Tennesseans enroll in new health care coverage options

Beth UseltonProgram Officer

Baptist Healing Trust

Lisa PoteSenior Vice President

Seedco of the Midsouth

Background• Project launched in November 2012 as a public/private partnership with

the Tennessee Insurance Exchange Planning Initiative to provide consumer assistance for the state-based marketplace

• In December 2012, Governor Haslam announced that his administration would not administer the exchange in Tennessee

• BHT leadership to propel the project as a private collaborative effort

• Baptist Healing Trust was tasked with:• Recruiting an advisory council

• Convening potential community partners

• Conducting preliminary strategic planning

• Researching best practices

Name Organization Position

Nancy Anness, APN St. Thomas Health Vice-President of Advocacy, Access and Community Outreach

Ashley Arnold Insurors of Tennessee General Counsel & Chief Operations Officer

Pete Bird Frist Foundation Chief Executive Officer & President

Denise Bollheimer Bollheimer ConsultingCEO (Founder & former Chair, Healthy Memphis Common Table)

Rae Bond Chattanooga Medical Society and Project Access Executive Director

Dr. Brian Bonnyman, MD Cherokee Health Systems Family Physician

Dr. Teresa Cutts, PhDCenter of Excellence in Faith & Health, Methodist Le Bonheur

Director of Research & Innovation; (Congregational Health Network)

Brian Haile, JD Jackson Hewitt

Senior VP for Health Policy (Former Director of the Health Insurance Exchange Planning Initiative for the State of TN)

Tavarski Hughes Blue Cross Blue Shield of TN Public Policy Liaison

Dr. Carole Myers, PhD, RN University of Tennessee College of Nursing

Associate Professor (Former Co-Director of UT Center for Health Policy & Services Research)

Elliott Moore Mountain States Health Alliance; Project AccessDirector of Community & Government Relations

Dr. Ken Robinson, MD Shelby County Mayor's OfficePublic Health Policy Advisor (Former Commissioner of Health for State of TN)

Dr. Cathy Self, PhD Baptist Healing Trust Chief Executive Officer & President

Maitane Tidwell Inclusive Communications President

Carol Westlake Tennessee Disability Coalition; Executive Director (also Chair of Middle TN Safety Net Consortium)

Pam Wright, JD West Tennessee Legal Services Attorney, Elder Law Specialist

Dr. Jan Young, PhD, NP Assisi Foundation of Memphis Executive Director

Advisory Council

• Monthly meetings of the Advisory Council• Strategic planning• Funder briefings• Identified lead agency – Seedco • Recruiting potential community partners

– For Navigator proposal & other opportunities to partner– Survey of 200+ non-profit organizations

Where are we today?

Over 900,000 uninsured Tennesseans will be eligible for health insurance under the

Patient Protection and Affordable Care Act*

January 1, 2014

The “Tennessee plan”Private insuranceCost-sharing for

certain visitsNo wrap-around

servicesCommercial

standards for appeals of denial

Payment reform

On March 27th, Governor Haslam announced his intention to develop a plan to use Medicaid funds allocated to Tennessee under the ACA to provide private insurance to uninsured Tennesseans under 100% of the federal poverty line.

* To implement the plan, he will need:1. Approval from Center for Medicaid &

Medicare Services (CMS)2. Votes from Tennessee General

Assembly to appropriate funding

FPL

400%

300%

200%

100%

Children Undocumented Immigrants

Adults w/o Children

People with Disabilities

ParentsPregnant Women

0% 0%

■ TennCare & CoverKids Marketplace (Exchange)

■ Uninsured

Tennessee Plan

Subsidized

Unsubsidized

Linking Uninsured Tennesseans to Coverage

400,000

525,000

Remain uninsured if

no deal

138%

Who is eligible for help?

Federal Poverty Level*

AnnualHousehold income

Medicaid (TennCare)

Health Insurance Marketplace

Premium Tax Credits

Cost-sharing subsidies

Single Family of four

To apply directly to private plan monthly

premiums

Offset out-of-pocket costs

like deductibles & copays

< 100% ? - -

≥ 100% $11,490 $31,322 X X X

100-250% X X X

≥ 250% $28,725 $58,875 X X X

250-400% X X

≥ 400% $45,960 $94,200 X* 2013 Poverty Levels

Case Study #1

The Jones

• Married, no children• Own a small business• Purchase their own health

insurance• Annual combined income

= $60,000

Poverty Level: 382%Coverage Option(s): MarketplaceMaximum annual premium =

$6,036 / year(9.5% of income)

Subsidies: Premium Tax Credit = $336 No cost-sharing subsidiesMaximum out of pocket = $5,700

Case Study #2

The Gonzalez Family

• Family of four• Both parents work full-time• No insurance offered at

work• Annual combined income

= $50,000

Poverty Level: 209%Coverage Option: MarketplaceRegular annual premium =

$9,869Maximum annual premium

they will pay = $3,314(6.63% of income)

Subsidies: Premium Tax Credit = $6,555 + Cost-sharing Subsidies

Case Study #3

The Reynolds

• Couple, no children• Jean works full-time for

minimum wage:

$7.25 / hour

$15,080 / year• No health insurance

offered at work

Poverty Level: 96%Coverage Option:

Marketplace, full price

Annual premium = $6,036

(40% of income)No TennCare, No Subsidies

Who is left uncovered?1. Undocumented immigrants

• Estimated 120,000 to 140,000 undocumented immigrants living in TN1

2. Those left uncovered without TennCare Expansion

• Estimated 180,000 to 225,000 2

• Childless adults• Parents of children who are on TennCare but do not

qualify for coverage themselves

3. Those who neglect or refuse to enrollSources:1) "Distribution of Illegal Aliens by State." Federation for American Immigration Reform (FAIR), 2011. Web. 28 May 2013.

<http://www.fairus.org/issue/how-many-illegal-immigrants#end>.2) University of Memphis; BCBST; American Journal of Managed Care; Division of Healthcare Finance and Administration.

Small Businesses

Individuals & Families

SSA

Qualified Health Plans

Federal Health

Insurance Marketplace

How will people enroll?

IRS INS

To verify income, social security benefits and citizenship status

and determine tax creditSmall Business

Group Health Plans

http://www.covertn.gov/web/cover_kids.html

No wrong door

14

Single, streamlined application

Step 1: Tell us about yourself

Step 2: Current job and income information

Step 3: Your health coverage

Step 4: Sign & submit

21 page application reduced to 3 pages

Forms available online:http://www.cms.gov/CCIIO/Resources/Forms-Reports-and-OtherResources/ Downloads/AttachmentC_042913.pdf

http://www.cms.gov/CCIIO/Resources/Forms-Reports-and-Other-Resources/Downloads/AttachmentC_042913.pdf




Easy Shopping Experience

• Easy-to-read format• Glossary of terms

(deductible, co-pay, etc)

• Costs & benefits in plain English on two sheets of paper

The ChallengeThe majority of uninsured Americans don’t know

the health reform law will help them.

75% of the newly eligible want in-personassistance to learn about and enroll in coverage.

Source: Enroll America Research, November 2012

78% of the uninsured don’t know about the new health insurance exchanges

83% of people who could be eligible for the new Medicaid expansion don’t know about it

How will they know?Where will they turn for help?

Consumer Assistance

Public Education & Community Outreach

Who are the uninsured in Shelby County?

142,645uninsured residents

These estimates are available on the CMS website at http://cms.hhs.gov/OutreachandEducation/Outreach/HIMarketplace/Census-Data-.html. CMS and ASPE used the Census Bureau’s 2011 American Community Survey (ACS) for the analysis, and all estimates represent the eligible uninsured population aged 0-64.


138% or Less 139-400% Above 400%0

10,00020,00030,00040,00050,00060,00070,00080,00090,000

100,00087,251

45,512

9,883

Relation to FPL, Shelby County

Percent of Federal Poverty Level

Nu

mb

er o

f R

esid

ents



Under 18 19-25 26-34 35-54 55-640

10,000

20,000

30,000

40,000

50,000

60,000

15,886

25,236

33,826

54,041

13,659

Breakdown by Age, Shelby County

Age

Nu

mb

er o

f R

esid

ents



81,516

57%

61,129

43%

Breakdown by Gender, Shelby Co.

Men Women



88,84063%

36,135 26%

13,526 9%2,3022%

Breakdown by Ethnicity, Shelby Co.

African Amer-ican

White

Latino

Multi-Cultural



97,027have a full-time worker in family


And we only have 97 days

until

October 1, 2013

SeedCo of the MidSouth, based in MemphisWho is Seedco?

Seedco is a national nonprofit intermediary with more than 25 years of experience in managing complex, multimillion-dollar federal contracts that connect low-income individuals and families with the resources they need to be successful.

What Seedco Does:

We develop, implement and learn from model programs that combine evidence-based research and innovative ideas with outcome-driven management practices.

Lead Agency

The Problem:• Enrolling over 500,000 people (without

Medicaid expansion) 100-400% of poverty

• $1.4 million is not going to do it• Because of Medicaid expansion

decisions, there will be a LOT of people who are not eligible for the Marketplace that will need other assistance

• Lots of confusion, mistrust of government and the ACA

• Political environment of pressure to get it right

The Opportunity:• Creating a framework from which a

broad range of stakeholders and engage and interact with insurable individuals

• A willingness on the part of providers to step up without Navigator funding

• Leverage the strengths of all to complement each other to reach as many people as possible

Seedco Navigator Grant Summary:• $1.3 million • 18.5 Navigator positions• Focus on high-population areas urban

areas with swing navigators through high-density rural areas.

• Emphasis on connecting navigators with community-based CACs… Natural points of entry for target populations.

• Funding announcements made August 15

Middle Tennessee 318,484 Uninsured

6 Navigators

West Tennessee227,278 Uninsured

6 Navigators

East Tennessee334,218 Uninsured

6.5 Navigators

What is a Navigator? Individual or entity that:

1) Conducts community outreach activities to identify uninsured individuals and small businesses

2) Raises public awareness about new marketplace options

3) Facilitates enrollment of eligible individuals and small businesses into Qualified Health Plans (QHPs) through the health insurance marketplace

Have or able to establish relationships with Employers & employees Consumers, including uninsured & underinsured Self-employed individuals

What is Required?Navigators must have expertise in:

eligibility & enrollment rules & procedures the needs of underserved & vulnerable populations privacy & security standards

Must be capable of carrying out: facilitating selection of Qualified Health Plans providing fair, accurate, impartial information

culturally & linguistically appropriate accessible to individuals with disabilities

providing referrals for grievances

Certified Application Counselors(CACs)

Appeared in regulation in January 2013: “…trusted community-based organizations,

providers, or other organizations with expertise in social service programs.”

“…employees and volunteers of organizations, which may include health care providers and entities, as well as community-based organizations, among other organizations.”

Training Standards

Navigators & CACs must be trained in:

Qualified Health Plan options in the Exchange

Affordability programsPremium tax creditsCost-sharing subsidies

Eligibility & benefits for TennCare & CoverKids

<30 hours

of online

training

Continuing Education

Required for Certification & Recertification

New consumer assistance in the Tennessee marketplace

Navigators Certified Application Counselors

Community outreach Public education

Distribute fair & impartial information

Facilitate enrollment Qualified health plans TennCare CoverKids

Provide referrals for grievances

Distribute fair & impartial information

Facilitate enrollment Qualified health plans TennCare CoverKids

Provide referrals for grievances

Consumer Assistance

Agents & Brokers

NavigatorsCertified

Application Counselors

Carrier commissions for QHPs

No funding mechanism built in

Federal grants

Private funding?

no commission for TennCare/CoverKids

Target Group? Employees Insurable and

Uninsurable Individuals

InsurableIndividuals

Where? Work Places Health Places Life Places

Examples of Locations

Less than 50 employees HospitalsFQHCs

Charity centersDoctor’s offices

Technical collegesTax prep centersLarge box stores

SchoolsNeighborhoods

CBOs

Who Will Enroll?Brokers Navigators CACs Navigators and CACs

Funded How?

Commissions

Federal Funding

Private funds, other fundraising

Navigator funds and foundation funding

Navigator Planning/Foundational Assumptions:

500,000 people will get enrolled in a lot of different places.

What role can medical providers play in outreach

and enrollment?

1. Inform your clients– Tell them about their new options

• There will be new, affordable options available for people without insurance.

• All insurance plans will have to cover doctor visits, hospitalizations, maternity care, emergency room care, and prescriptions.

• Financial help is available so you can find a plan that fits your budget.

• All insurance plans will have to show the costs in simple language with no fine print.

– Provide referrals for enrollment assistance

What role can medical providers play in outreach

and enrollment?

2. Identify staff to help as Certified Application Counselors (CACs):

– Social Workers– Intake / Front Office staff– Case Managers

Elements of a Successful Outreach and Enrollment Campaign:

• Focusing on existing strengths. • Creating a network that is scaleable for when

Medicaid is expanded in some form (Tennessee Plan, etc…).

• Creating a culture of: communication and information dissemination best-practice sharing continues learning/improvement across the state.

• Ensure that every partner is participating, in someway, that has a vested interest in seeing the success of successful enrollment effort.

What’s Happening THIS Summer

• Traveling across the state– Presentations to local stakeholder groups– Collaborations that will improve outcomes for

success.• Building a fundraising strategy that will

advance and contribute to success. – Increasing capacity of communities to engage

in broader outreach and enrollment efforts.

Are you interested in partnering with Get Covered Tennessee?

1. Complete the Navigator Survey for Community Partners (and complete the CAC section):

https://www.surveymonkey.com/s/navigatorsurveybht

2. Join our email list for updates:

https://app.e2ma.net/app2/audience/signup/1741403/1724393/?v=a

3. Contact Seedco:

[email protected]

(901) 528-8341

https://www.surveymonkey.com/s/navigatorsurveybht





mailto:[email protected]

Documents

Get Covered Tennessee A coordinated statewide initiative to help uninsured Tennesseans enroll in new health care coverage options Beth Uselton Program