1. Tapping the Community Based Infrastructure to Maximize Outreach and Consumer Assistance Indiana ACA Symposium March 15, 2013 Tricia Brooks

2. Many Will Need Individualized Assistance o Becoming aware of new options and personal responsibility to have coverage o Determining if they qualify; how to apply o Overcoming language, cultural or accessibility barriers o Choosing an insurance plan o Understanding implications of premium tax credits and cost-sharing subsidies o Maneuvering different sources of coverage for different family members

3. One Size Consumer Assistance Doesn’t Fit All o Even people who prefer to apply online from home like knowing they can get help o Studies show mixed preferences for assistance in-person, online or over the phone o Diversity of assistance and assisters is key to meeting consumer needs o Experience shows that trusted, community-based organizations are essential 3

4. Meeting the Needs of Consumers Needs (Demand) – Accessibility – Demographics Resources (Supply) – Capacity and expertise of consumer assisters Other factors impacting need for assistance – Communications & marketing – Technology ease of use – Eligibility & enrollment process – Coordination between agencies 4 Consumer Needs }

5. Supporting Digital Age Consumer Self-Service o Consumer-tested, easy-to-use online applications with dynamic questioning o Pop-up help boxes; alerts o E-Chat o Personal accounts o Upload documents o Electronic notices o Co-browsing 5 Supporting consumer self-service is as important a consumer assistance service as providing a human touch!

6. NAVIGATORS A Required Component of all Types of Exchanges: State-Based Federally-Facilitated Partnership 6

7. Who can serve as navigators? Explicitly excluded from serving as navigators: Health insurance issuers Subsidiaries of issuers Associations with members, or that lobbies on behalf of, the insurance industry An entity or individual with a conflict of interest At least one community or consumer-focused nonprofit, plus at least one of these entities: Chambers of commerce Licensed agents and brokers Trade/industry associations Commercial fishing, ranching and farming organizations Unions SBA resource partners Other public/private entities (i.e. tribal organizations or state/local government offices)

8. What eligibility criteria must navigators meet? o Be capable of carrying out the duties o Have relationships or can easily establish relationships with those likely to be eligible for enrollment in a QHP o Employers and employees o Consumers (including uninsured and underinsured) o Self-employed individuals o Meet licensing, certification or other standards prescribed by the state or Exchange o Have no conflicts of interests o Comply with privacy and security standards

9. What are the required duties of navigators? Navigators Knowledge of all QHP options, as well as Medicaid, CHIP and BHP (if application) Maintain Expertise Conduct outreach and education ✔ Provide fair, impartial information on all QHP options ✔ Provide culturally and linguistically competent information, and in a manner that is accessible for people with disabilities ✔ Comply with privacy and security standards ✔ Have no conflicts of interest ✔ Refer consumers for grievances or appeals ✔

10. How will the FFE select navigators? o HHS will award grants, train and manage o Federal funding opportunity announcement (expected soon) o Organizations can take early steps to be ready by registering – get a registration checklist here: http://grants.gov/assets/organizationregcheck _092112.pdf http://grants.gov/assets/organizationregcheck _092112.pdf 10

11. CERTIFIED APPLICATION COUNSELORS 11 Proposed standards in latest 1/14/13 Notice of Proposed Rule Making released; subject to final rulemaking.

12. Building on Existing Community-Based Application Assistance Infrastructures o Option in Medicaid; required in Exchange o Exchange must certify Medicaid CAC’s o Staff and volunteers assist with application, renewal, documentation requirements, ongoing case management o Regulations are intended to ensure: 12 o Training, skills to provide reliable, effective assistance o Meet confidentiality and conflict of interest standards o CACs are authorized to have access to an individual’s tax related data

13. State Requirements o Establish web-portal used only by certified application assisters (proposed for Medicaid only) o Establish procedures o Inform applicants and enrollees of CAC functions and responsibilities o Allows individuals to authorize CAC to assist; authorization is required before CAC are provided confidential information o Ensure that CACs do NOT charge for their assistance 13

14. Our Panel: Jenny Sullivan Enroll America Sherry Gray St Vincent Health J Hopkins Wishard Hospital 14

15. Georgetown Health Policy Institute Center for Children and Families o Tricia Brooks Assistant Research Professor – Georgetown Health Policy Institute Senior Fellow – Georgetown Center for Children and Families pab62@georgetown.edu 202-365-9148 o Our Website: http://ccf.georgetown.edu/http://ccf.georgetown.edu/ o Our child health policy blog: Say Ahhh!http://www.theccfblog.org/http://www.theccfblog.org/