1. IN THE MIX: PREPARING TO BE ASSISTERS Prepared by California Coverage and Health Initiatives (CCHI) June 2013 1

2. Our Agenda 2  Enrolling California’s Uninsured in Health Coverage  Role of the Exchange in Shaping the Assister/Counselor Roles  Enrollment Entity Roles and Responsibilities  In-Person Assisters  Navigators  Certified Application Counselors  Which Role is Right for You?  Training Opportunities

3. Enrollment System Guiding Principles 3 CCHI believes California’s enrollment system should:  Build off the strengths of existing organizations  Involve small CBOs  Help assisters/enrollment counselors in their role

4. California’s New Health Insurance Marketplace 4 www.healthexchange.ca.govhttp://www.dhcs.ca.gov www.coveredca.com

5. Who Will Need Help Enrolling in Coverage? Source: Covered California 5  In 2014, 5.3 million Californians will be eligible to purchase insurance through the exchange :  2.6 million will qualify for premium assistance  All will benefit from guaranteed coverage

6. Who Are California’s Uninsured? 6 By ethnicity: Source: Covered California

7. Enrollment Assistance in California 7 Covered California has several types of Enrollment entities and Assister/Counselors:  Paid Assisters/Counselors  In-Person Assisters  Navigators  Unpaid Assisters/Counselors

8. What Does the Enrollment Assistance Program Aim to Do? Source: Families USA 8 It engages Enrollment Entities and individual counselors who:  Conduct outreach and education to help people figure out their coverage options  Help consumers and small employers learn about and enroll in coverage  Help with the application process, translate materials and breakdown barriers

9. Who Can Be an Enrollment Entity? 9  Community Based Organizations (CBOs) and other consumer focused groups  Organizations with existing relationships with key eligible populations  Assisters/Counselors cannot:  Have conflicts of interest  Be health insurers or accept any form of payment from insurers related to enrollment

10. What Will the Enrollment Entities and Enrollment Counselors’ Role Look Like? 10 Covered California is in the process of determining:  What types of entities are eligible to be Navigators/IPAs  How they will be paid  Oversight and monitoring  How Enrollment Assistance Program will work with the Medi-Cal population

11. Program Overview 11 Enrollment Assistance Program Unpaid Health Care Providers Agents Other Entities Paid In Person Assisters $58/Enrollee $25/Re-enrollee Navigators Grant Program

12. In-Person Assistance Program (IPA) Overview 12 IPAs Funding SourceEstablishment Costs Compensation Fee-for successful initial enrollment into Covered California QHP ($58) or renewal ($25) Program starts:October 2013 Source: Covered California

13. IPA Program Timeline 13 Source: Covered California

14. Navigator Requirements 14 There are six major navigator requirements:  Provide outreach and education  Assist with enrollment  Expertise in eligibility and enrollment  Offer services in a fair and impartial manner  Provide referrals to ombudsmen or other consumer assistance programs  Make available information in a manner that is culturally and linguistically appropriate

15. Navigator Program Overview 15 Navigators Funding SourceFees on Health Plans Compensation Grant program based on enrollment targets Program starts: January 2014, but initial payments may be delayed Source: Covered California

16. Navigator Program Timeline 16 Source: Covered California

17. Comparing IPA and Navigator Programs 17 Roles & ResponsibilitiesIPA ProgramNavigator Program Conduct public education activities to raise awareness of the availability of Covered California products X Distribute fair and impartial information concerning enrollment into qualified health plans XX Facilitate enrollment into qualified health plan available through Covered California XX Provide referrals to Consumer Assistance Programs XX Provide information that is culturally and linguistically appropriate XX Source: Covered California

18. Enrollment Assistance Application Process 18 Eligible organizations and their employees may apply to register for the In-Person Assistance or Navigator Program by: 1. Submitting a completed application 2. Passing the Assister Fingerprinting and Criminal Record Check 3. Completing the required training established described in Section 6660 and pass the exam

19. A Third Role: Certified Application Counselors (CACs) 19 Covered California and DHCS will certify staff and volunteers to become CACs, who will:  Help consumers apply and enroll in Exchange coverage and Medi-Cal  Provide “the same core application assistance services” and have similar training requirements and conflict of interest standards to other enrollment assistance roles  Not be paid by the Exchange  Be unable to charge fees to consumers

20. What is the Role of Insurance Agents? 20 In California agents or brokers will:  Enroll individuals and small employers in qualified health plans and public programs  Assist individuals in applying for premium assistance/tax credits and cost-sharing reductions in exchanges

21. Agents and Enrollment Entities Working Together 21  Nonfinancial working partnerships between agents and Enrollment Entities are encouraged  Regulations prohibit financial relationships between CEEs and CECs and anyone who holds a current license from California Department of Insurance

22. Which Role to Play? 22 Organizations will not be able to pursue both the IPA and Navigator role and should consider the following:  Does your organization want to offer IPA and collect a per successful application fee that is only funded until 2015? OR  Go after a grant that is likely to be funded over a longer period of time?

23. Requirements in Process 23 Covered California has finalized the IPA portion of the Enrollment Assistance Program regulations. These provide guidance on:  Background checks, fingerprinting and liability insurance for individual assisters  Types of trainings and training topics  Relationships between agents and Certified Enrollment Entities Full-text of the regulations can be found here: http://www.healthexchange.ca.gov/BoardMeetings/Docu ments/June%2020,%202013/Enrollment%20Assistance% 20Regulations%20(FINAL).pdf http://www.healthexchange.ca.gov/BoardMeetings/Docu ments/June%2020,%202013/Enrollment%20Assistance% 20Regulations%20(FINAL).pdf

24. Training and Oversight 24 Training standards for Certified Enrollment Entities and Counselors include:  Addressing the needs of underserved and vulnerable populations  Familiarity with qualified health plans (QHPs), public insurance programs, premium assistance/tax credit and cost sharing  Understanding eligibility and enrollment rules and procedures  Adherence to privacy and security requirements

25. Enrollment Program Training Topics  Basic concepts about health insurance and the exchange, enrollment and individual responsibility  Outreach methods and strategies  Eligibility, application requirements and appeals  Enrollment procedures, processes and tracking systems  QHP/Medi-Cal/Healthy Families operations, plan options and benefit limits  Premium assistance/Tax Credits, deductibles and cost-sharing requirements  Understanding of cultural and linguistic standards and the needs of underserved and vulnerable populations  Access standards for individuals with disabilities  Referral to appropriate agencies for additional information  Code of Conduct and Ethics  Customer services standards  Privacy and security standards 25

26. CCHI Member/Partner Areas of Expertise 26  Premium assistance/Tax Credits, deductibles and cost-sharing requirements  Understanding of cultural and linguistic standards and the needs of underserved and vulnerable populations  Referral to appropriate agencies for additional information  Access standards for individuals with disabilities  Code of Conduct and Ethics  Customer services standards  Privacy and security standards  Basic concepts about health insurance and the exchange, enrollment and individual responsibility  Outreach methods and strategies  Eligibility, application requirements and appeals  Enrollment procedures, processes and tracking systems  QHP/Medi-Cal/Healthy Families operations, plan options and benefit limits

27. New Skill Sets 27  Basic concepts about health insurance and the exchange, enrollment and individual responsibility  Outreach methods and strategies  Eligibility, application requirements and appeals  Enrollment procedures, processes and tracking systems  QHP/Medi-Cal/Healthy Families operations, plan options and benefit limits  Premium assistance/Tax Credits, deductibles and cost-sharing requirements  Understanding of cultural and linguistic standards and the needs of underserved and vulnerable populations  Access standards for individuals with disabilities  Referral to appropriate agencies for additional information  Code of Conduct and Ethics  Customer services standards  Privacy and security standards

28. Next Steps for Your Organization 28  Educate your Board and community partners about the programs  Consider your organizational structure and what role might work best for your organization  Develop a plan that includes training, goals and a readiness timeline  Complete the Enrollment Entity Interest form here: https://assisters.ccgrantsandassisters.org/ https://assisters.ccgrantsandassisters.org/  Officially apply to become a Certified Enrollment Entity

29. Reports Referenced in Presentation 29  Covered California, Assisters Program: In-Person Assistance and Navigator Webinars  Families USA, Interested in helping with enrollment in the federal insurance marketplaces?  State Health Reform Assistance Network, Designing Consumer Assistance Programs: Resources from the Field  CCHI and others, Health Benefit Navigator Credentialing, Training and Quality Assurance in California

30. Who to Contact: 30 INSERT your organization’s contact information HERE

31. Feedback or Questions about this Presentation? 31 Suzie Shupe Executive Director California Coverage & Health Initiatives 707-527-9213 sshupe@cchi4families.org www.cchi4families.org