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The Impact of the Affordable Care Act on Safety Net Providers and their Patients: Opportunities for Outreach and Education. What We’ll Cover. Expansion of Health Insurance Coverage Application and Eligibility Consumer Assistance Resources What Providers Can do to Help
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Many uninsured patients will become eligible for affordable health care coverage beginning in 2014.
The Affordable Care Act:
Enrollment starts October 1, 2013
Coverage begins as early as January 1, 2014
Helps enhance competition in the health insurance market.
Increases Affordability through premium tax credits, cost sharing reductions, or public insurance programs.
Ensures Quality through QHPs that must meet basic standards, including quality standards, consumer protections, and access to an adequate range of clinicians.
Makes Costs Clear by providing information about prices and benefits in simple terms consumers can understand, so they don’t have to guess about costs.
State-Based (SBM):16 States & DC are setting up & managing their own Marketplaces.State Partnership (SPM): 7 States are working in partnership with the federal government.Federally-Facilitated (FFM):In 27 States the federal government is setting up the Marketplace.
Source: Kaiser Family Foundation. Status of State Health Insurance Exchange Decision, as of July 1, 2013, available at http://kff.org/health-reform/state-indicator/state-decisions-for-creating-health-insurance-exchanges-and-expanding-medicaid/#
% of Federal Poverty Level (FPL)
Familyof 4 household income*
*Based on 2013 Federal Poverty Guidelines
* ($15,282/year for an individual, $31,322/year for a family of 4)
Source: Kaiser Family Foundation. Status of State Medicaid Expansion Decision, as of August 28, 2013, available at http://kff.org/medicaid/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/#
* $11,500 per year as a single person (about $23,500 for a family of 4
* unless eligible for other minimum essential coverage as defined in IRC 5000A(f)
After these new options are implemented, there may still be up to 31 million uninsured persons in the U.S in 2023, including:
One streamlined application to apply for Medicaid, the Children’s Health Insurance Program (CHIP), the new Health Insurance Marketplace, and tax credits that will help pay for premiums in the Marketplace.
Eligible for Marketplace or
Supported by Data Services Hub
Support for 150
Online/phone/in personEnrollment Assistance
Notices & letters
Ongoing customer service
User Account Assistance
API available for other sites
Email & text updates
Listed on www.HealthCare.gov in Local Help & Customer Service Referrals
Navigator Grant program sponsored by each Marketplace to provide consumer assistance.
Navigators have a number of responsibilities including, but not limited to:
Maintaining expertise in eligibility, enrollment, and program specifications and conduct public education activities.
Providing accurate and impartial information about QHPs and other health programs such as Medicaid and CHIP.
Facilitating selection of a QHP.
Providing information in a manner that is culturally and linguistically appropriate and accessible for people with disabilities.
Navigators must be trained and certified.Navigator Program
Optional for State-based Marketplace.
Required for State- Partnership Marketplace.
In-Person Assisters perform generally same functions as Navigators.
In most cases, have similar role and responsibilities.
In-Person Assisters have comprehensive training and certification requirements similar to Navigator program.In-Person Assisters
Educate consumers about insurance affordability programs and coverage options.
Help consumers apply for coverage through the Marketplace.
Have more limited role than other assisters.
Do not receive federal Marketplace grant money
May receive other private, state, or federal fundingCertified Application Counselors (CAC)
CAC Training is available at:
Link to CAC training: https://marketplace.medicarelearningnetworklms.com
Link to CAC training content: http://marketplace.cms.gov/training/get-training.htmlCAC Application & Training
Then Direct to Customer Service
Aren’t displayed in Find Local Help tool and aren’t consumer referral points – educators refer consumers
A new way to recognize organizations who are engaged in outreach and education efforts.
Organizations can fill out an online form on marketplace.cms.gov/help-us/champion.htmlto become publically recognized as a “Champion.”
Outreach activities can include:
Sending emails to their networks about the Marketplace.
Posting the HealthCare.gov widget on their website.
Recording and sending out PSAs about the Marketplace.
Hanging posters and/or giving out fact sheets and brochures about the Marketplace.
Hosting a conference call, webinar, or another educational event about the Marketplace.
1. Educate patients:
Healthcare.gov is where consumers can go to:
Learn about their health insurance options;
Get accurate information on different plans;
Apply for and enroll in coverage; and/or
Get directed to the Marketplace in their state.
Assisters will be listed on the site so consumers can find local help.
Get the latest resources to help people apply, enroll, and get coverage in 2014
Assistance available 24/7
English, Spanish, and 150 languages
June – September
Call Center will provide general information to consumers and employees of SHOP employers.
Starting in October
Call Center will help with eligibility, enrollment, and referrals.
State-based Marketplaces will have their own call centerand consumers will be referred as appropriateNational Marketplace Call Center