The ACA and You: Your Center, Your Community CenterLink’s 7 th Annual Executive Director & Board Leadership Summit 1 Heather Bates, LMSW

Enroll America 2 Our Mission Maximize the number of uninsured Americans who enroll in health coverage made available by the Affordable Care Act Two-fold Strategy Promoting Enrollment Best Practices National Enrollment Campaign Using Cutting Edge Engagement Strategies 1 2

Sampling of Our Partners 3

The Best Practices Institute 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

Uninsured Nationally 5 Rates of Nonelderly Uninsured Total18 % Adults % Black21 % Hispanic32 % % FPL32 % Source: Kaiser Family Foundation State Health Facts, based on the U.S. Census Bureau’s 2011 and 2012 March Supplements to the Current Population Survey

The Uninsured Nationally: Who are the Eligible Uninsured? 6 55%45% Source: Source: Centers for Medicare and Medicaid Services’ (CMS) analysis of the 2011 American Community Survey (ACS)

The 2014 Enrollment Opportunity 7 Source: May 2013 CBO estimates Millions Enroll at least 16 million people in new coverage options } 7 million in Exchange (“Marketplace”) coverage 9 million in Medicaid or CHIP } Source: May 2013 CBO estimates

The Uninsured in New York 8 Rates of Nonelderly Uninsured Total15 % Women14 % Adults (19-64)18 % African American19 % Hispanic23 % Source: Kaiser Family Foundation State Health Facts, based on the U.S. Census Bureau’s 2011 and 2012 March Supplements to the Current Population Survey

The Uninsured in New York: Who are the Eligible Uninsured? 9 57%43% Source: Source: Centers for Medicare and Medicaid Services’ (CMS) analysis of the 2011 American Community Survey (ACS)

Insurers can no longer charge women more just because they’re women. AND All plans in the new marketplaces must cover essential women’s health care like maternity care. Specific Benefits for Women

Essential Health Benefits 1.Ambulatory patient services 2.Emergency services 3.Hospitalization 4.Maternity and newborn care 5.Mental health and substance use disorder services, including behavioral health treatment 6.Prescription drugs 7.Rehabilitative and habilitative services and devices 8.Laboratory services 9.Preventive and wellness services and chronic disease management 10.Pediatric services, including oral and vision care

Free preventive services for women include:  Well Woman Visits  All FDA-approved contraception methods and contraceptive counseling  Mammograms  Pap smears  HIV and other sexually transmitted infection screening and counseling  Breastfeeding support, supplies, and counseling  Domestic violence screening and counseling Preventive Services for Women

13 Awareness is Increasing Lack of awareness provides opportunity for education with effective messaging Many of the uninsured still don’t know about their options 43% Source: Enroll America, November 2012 of the uninsured don’t know about the new health insurance marketplace options November 2012 August 2013 Source: Kaiser Family Foundation, August 2013 Enroll America still has work to do, but the uninsured are hearing more and more about the new options available to them 78% of the uninsured don’t know about the new health insurance options

Awareness is Increasing 14 But many of the uninsured still don’t know Source: Enroll America *Source: Kaiser Family Foundation Still Many Are Unaware

Messaging Research Design 15

Past Experiences Seeking Coverage have shopped for insurance outside their job 44% have been uninsured for 2 years or more have been uninsured for 2 years or more 67% Source: Enroll America, November

Shopping for Coverage 17 Source: Enroll America, November 2012

Reactions to New Coverage Options 18 Source: Enroll America, November % 16% 12%

Key Findings Across Segments 19 Almost all (91%) believe health insurance is necessary or very important. Cost and affordability are the biggest barriers.Financial & health security are the biggest motivators.Deep skepticism & confusion among consumers.

All insurance plans will have to cover doctor visits, hospitalizations, maternity care, emergency room care, and prescriptions. You might be able to get financial help to pay for a health insurance plan. If you have a pre-existing condition, insurance plans cannot deny you coverage. All insurance plans will have to show the costs and what is covered in simple language with no fine print. 4 Key Messages Reach Most Uninsured One of these = top message for 89% of population

Single, Streamlined Application Consumers can connect to whichever program they are eligible for, no matter where they start. Complete single application Determine eligibility Enrolled in correct program! Medicaid CHIP In-Person Assistance Exchange Single Application 21

Public Perceptions 22 75% Three out of four of the newly eligible want in-person assistance to learn about and enroll in coverage. Help gets them from here… …to here. Source: Enroll America, November 2012

Developing Targeted Messages 23 78% don’t know about their options in 2014 Essential care covered by plans No pre-existing condition denials Financial help is available Simple language and no fine print Financial security – from bankruptcy/bills Health security – coverage for the care you need Plans that fit your budget State govt whose job it is to help Medicaid offices, family members, doctors 73% use internet frequently, 68% Facebook, 31% smart phone, 68% text 66% likely to go to exchange website to find and compare plans Facts They Need to Know Top Motivating Concepts Best Messengers Connected + Online Example: Messaging to reach and motivate women

Incorporating Best Practices in Your Work 24 Before the appointmentDuring the appointmentPost appointment

25 Develop a referral network with organizations who provide application assistance Help consumer make an appointment Give them a reminder (text or call) the day before Make sure they have transportation to the appointment Before the appointmentDuring the appointmentPost appointment Incorporating Best Practices in Your Work

26 Before the appointment Build trust Answer questions Go slowly Provide the consumer with a next steps document for after the appointment During the appointmentPost appointment Incorporating Best Practices in Your Work

27 Before the appointmentDuring the appointment Follow up to make sure they’ve paid their premium Help them set up a primary care physician Follow up occasionally to: Confirm/update contact information Seeing if they’ve seen their primary care provider Reminding them about the upcoming open enrollment period Post appointment Incorporating Best Practices in Your Work

How Can Providers Help? 28 Train staff on four key messages Clinicians and outreach, administrative staff Consider getting staff trained as Certified Application CounselorsIdentify Navigators and other assisters who can help Partner with a local organization and develop referral relationships Offer space in your office for assisters to meet with patients Spread the word! Include information about healthcare.gov and the hotline on your voic , on- hold message, and website Hang posters in waiting room

Enroll America’s Campaign 29

Guiding Principles for the Campaign Data-driven and Metrics-based 2. Grassroots-focused 3. Coalition-based 5. Building a Narrative of Success

Data and Analytics, Micro-targeting Without Modeling, Campaign Would Miss Millions of Uninsured Modeling Identifies Uninsured at Individual Level Additional Testing Identifies Best Message + Tactic Example: In Houston, 120K out of 800K uninsured live in areas with low uninsured rates Example: Individual level targeting increases efficiency of volunteer outreach Example: Experiments identify which individuals respond better to mail or phone calls 119,508 Houston Uninsured MapExample Neighborhood 9%71%7% 23%66%35% Example Tactics + Message Mail – Security Msg. Call – Cost Msg. 31

Resources More Information On: Best practices in outreach and enrollment Exchange branding research Public opinion polling Statewide marketing and outreach plans 32

Webinar Archives Topics Include: Streamlining Enrollment Best Practices for Navigators Enroll America's Research and Message Findings Enrollment Assistance Options Review of States’ Public Education and Outreach Plans Enrolling Communities of Color Verifying Eligibility Health Literacy Concepts Single, Streamlined Application Federal Eligibility and Enrollment Regulations 33 enrollamerica.org/best-practices-institute/webinar-archives

Other Resources Outreach Planning 101 Tips for Talking with Your Patients About Their New Health Coverage Options (provider focused) Tips for Talking with Your Patients About Their New Health Coverage Options (provider focused) Ways that Community Health Centers Can Increase Outreach and Enrollment (webinar) Ways that Community Health Centers Can Increase Outreach and Enrollment (webinar) Presumptive Eligibility Toolkit for Hospitals Latino Engagement Toolkit Young American Engagement Toolkit African American Messaging Toolkit (Coming Soon!) Get Covered Mobile: Texting for Enrollment - Text COVERED to

State Profiles and Maps enrollamerica.org/best-practices-institute/states enrollamerica.org/maps

Questions? 36 Heather Bates, LMSW Northeast Regional Manager