AFFORDABLE CARE ACT: VA COMMUNICATION FRAMEWORK July 24, 2013 DEPARTMENT OF VETERANS AFFAIRS

VETERANS HEALTH ADMINISTRATION Affordable Care Act (ACA) Overview ACA represents comprehensive reform of the health care delivery system and is intended to expand access to coverage, control health care costs and improve health care delivery system. ACA requires most individuals to have minimum essential health care coverage for themselves and their dependents or make a payment when filing taxes for each month lacking coverage. – Enrollment in VA health care, CHAMPVA and Spina Bifida programs meet the minimum essential coverage standard. Certain individuals, based on their income, may be eligible for assistance to lower the cost of health care coverage premiums. States have the option to expand Medicaid eligibility to up to 138% of the Federal Poverty Level Establishment of Health Insurance Marketplaces where individuals and small businesses can compare policies and premiums, and buy insurance coverage. 2

VETERANS HEALTH ADMINISTRATION ACA and VA – Enrollment Changes Enrollment changes may occur as Veterans respond to the new choices that are available to them States’ decision on Medicaid expansion may impact health care choices for Veterans who may become newly eligible for Medicaid – ACA expands Medicaid eligibility up to 138% of the Federal Poverty Level – According to the 2010 VHA Survey of Veteran Enrollees’ Health and Reliance upon VA, 584,000 enrolled Veterans are also enrolled with Medicaid Those most likely to change their enrollment status are non-users or have low reliance on VA 3

VETERANS HEALTH ADMINISTRATION ACA and Veterans Enrolled Veterans can continue to use VA and other federal health care coverage including Medicare, Medicaid, TRICARE or private insurance. Since enrollment meets the requirement for coverage under the law, they are not eligible for assistance in purchasing insurance. ACA will give some Veterans the choice to decide whether to use VA for health care, or choose non-VA options. Increased choices have implications for VA in the areas of outreach and communications. Veterans will expect VA to be able to assist them in understanding their options and deciding what’s best for them and their families. 4

VETERANS HEALTH ADMINISTRATION VA’s Overarching Communication Strategy VA’s focus is two fold: – Educate Veterans that VA health care meets ACA health insurance standards and (for those not currently enrolled), promote VA health care as an option; and – Communicate to Veterans and their families the value of health insurance and provide information about the Marketplace to those not eligible for care through VA, including Veterans’ families. To execute a multi-faceted strategy to engage with Veterans, staff and other stakeholders about VA and ACA. – There are approximately 22M Veterans, 8.2M are enrolled in VA health care programs. – There are an estimated 1.3M uninsured Veterans, most are eligible for VA health care. To ensure consistent communications with these audiences, VA has developed key messages to share with Veterans and other VA beneficiaries. VA will communicate information on ACA, using various modalities starting in July

VETERANS HEALTH ADMINISTRATION VA Overarching Communication Strategy (cont.) KEY STAKEHOLDERSSPECIFIC GROUPS Veterans, Veterans Families, and the Public  Veterans (includes enrolled Veterans, transitioning service members, eligible but non- enrolled Veterans, and special categories of Veterans, e.g., student Veterans)  Veterans families  CHAMPVA and Spina Bifida Beneficiaries  Media and the General Public Internal and Interagency Audiences:  VA Leadership  VA Organizations and Staff Offices  VHA and VBA Program Offices  VISN/VAMC/Regional Office Leadership and Staff  Vet Center Staff and Volunteers  VA-DoD Sharing Offices  VA Call Centers  Other Federal Agencies, CMS Navigators, Counselors and Agents Stakeholders and Organizations:  Congressional Leaders and Veterans Committees Staffs  Veteran Service Organizations, Non Governmental and Military Service Organizations  State Directors of Veterans Agencies  Governors, Mayors, State Marketplaces  Non-VA Health Care Providers  Disabled and Veteran-Owned Small Businesses 6

VETERANS HEALTH ADMINISTRATION Key Messages VA wants all Veterans to receive health care that improves their health and well-being. – VA will assist Veteran and other beneficiaries to determine their eligibility for VA health care and other health coverage options. If enrolled in VA health care, a Veteran does not need to take additional steps to meet the health care law coverage standards. – The health care law does not change VA health benefits or Veterans’ out-of-pocket costs. Veterans and other beneficiaries not currently enrolled in VA health care can apply for enrollment at any time. – Our doors are open – applications are accepted online at by phone at VETS (8387), by mail, or in person at a VA medical facility. VA will continue to provide Veterans with high quality, comprehensive health care and benefits they earned through their service. Veterans’ family members and Veterans not eligible for VA care may secure coverage through the Marketplace. 7

VETERANS HEALTH ADMINISTRATION Planned VA Outreach Efforts Landing Site (interactive website with ACA information, comparison tool, etc.) – Veterans’ family members webpage with link to healthcare.gov Direct Mail Print/Online/Media Communications – Social Media (Facebook, Twitter, Blogs) In-Person Communication Tools Collaboration with other Federal agencies and partners – HHS, DoD, DOL, SBA – State Governors and State Veterans Agencies Leverage partnership opportunities – VSOs, NGOs, MSOs – Veteran small business owners – Grantees 8

VETERANS HEALTH ADMINISTRATION Communication Timeline 5/20136/20137/20138/20139/201310/2013 May 2013 Release interim content changeswww.va.gov Enhance call Center scripts Introduce approved communications materials e.g. FAQ, Fact Sheet at NLC summit Conduct focus group reviewwww.va.gov/aca Maintain intranet site for staff to access information / tools June 2013 Develop ACA website Release Health Benefit Explorer on va.gov/healthbenefits Release VHA staff training on ACA Finalize direct communications materials July 2013 Focus group ACA website and Explorer Launch featuring content & Health Benefits Explorerwww.va.gov/aca Release VAMC ACA communications toolkit Begin mailing ACA letters/ information package to enrollees Add ACA to Enrollment materials Release new streamlined 10-10EZ Expand call center staffing/hours; web-chat Release social media messages Identify facility ACA Advisors August 2013 Publish Vanguard article Continue ACA letter/packages to enrollees Begin outreach to not enrolled Veterans Continue enhancing content and capabilities on Release content for VSO, SDVA websites and print communications Present at VSO National Conferences Release PSAs and YouTube video Initiate outreach to States September / October 2013 Continue mailout of ACA letter to enrollees Continue outreach campaigns ACA Open Season begins 9

VETERANS HEALTH ADMINISTRATION VA ACA Landing Page 10

VETERANS HEALTH ADMINISTRATION VA Health Benefits Explorer 11

VETERANS HEALTH ADMINISTRATION 12

VETERANS HEALTH ADMINISTRATION Outreach Campaigns CBO plans to initiate outreach to 166,000 not Enrolled VA Education beneficiaries beginning in August CBO seeks opportunities to partner with VISNs to outreach to other not enrolled Veteran groups – High Potential Targets: Under Age 65, particularly Young Adults Low and Moderate Income Enrollment Eligibility, e.g., Service-Connected, Vietnam Vets Declining or Stable Markets Encourage facility leadership to form local alliances to indentify uninsured Veterans, and help them make informed choices about their health 13

VETERANS HEALTH ADMINISTRATION HHS ACA Outreach Efforts Educate the American public about the value of health insurance and to encourage purchasing insurance through the Health Insurance Marketplace for those who need it HHS launched a redesigned website HHS outreach and communications efforts include: Create call centers in 6 states to support the 34 states where the Federal Marketplace will be implemented (call centers are using VA-supplied scripts) Assistance to community health centers to help enroll people in health insurance 14

VETERANS HEALTH ADMINISTRATION VA Visibility on healthcare.gov 15

VETERANS HEALTH ADMINISTRATION Next Steps Release additional communication materials – Creditable Coverage letter – Add ACA to TAP and Demo (transition) presentations – Guides for Enrolled and Not Enrolled Veterans Enhance VA Health Benefits Explorer to identify other health care coverage options for Veterans Develop external Navigator (HHS) training materials Develop not enrolled and uninsured Veterans outreach campaigns 16

VETERANS HEALTH ADMINISTRATION Questions 17