1. Rural Outreach & Enrollment An Overview from the Federal Office of Rural Health Policy November 30, 2015 Helen Newton Federal Office of Rural Health Policy HRSA

2. FORHP Focus: Policy and Research Financial and TA Resources ACA Outreach and Enrollment Voice of Rural at HHS

3. Rural Americans, on average …. Are nearly 16 percent of the total American population. Are disproportionately older and therefore more likely than urban populations to be eligible for Medicare. Are more likely than urban Americans to have 1 or more chronic diseases. Are less educated than their urban and suburban counterparts. Are more likely than those in urban areas to be on food stamps. Are more likely to be uninsured than residents in urban areas.* Have lower income levels than urban and suburban counterparts.* Have access to fewer health resources than urban Americans. * Source: The Uninsured: An Analysis by Income and Geography,” Barker AR, Londeree JK, McBride TD, Kemper LM, Mueller K, RUPRI Center for Rural Health Policy Analysis, Rural Policy Brief, June 2013. http://cph.uiowa.edu/rupri/publications/policybriefs/2013/Uninsured%20Analysis%202013.pdf http://cph.uiowa.edu/rupri/publications/policybriefs/2013/Uninsured%20Analysis%202013.pdf Key Facts Regarding the Rural Uninsured

4. More likely to be eligible for coverage under the Marketplace. More likely to be eligible for coverage under Medicaid expansion if states chose to expand. The Rural Uninsured: What We Know

5. Effects of Medicaid Expansion on Rural Areas Note: MT’s waiver has been approved since this map was created

6. Majority of rural residents live in a state without plans to expand Medicaid. In select regions, Medicaid expansion appears to be contribute significantly in improving the disparity between rural and urban uninsurance rates. Variation amongst states in Medicaid expansion partially explains rural-urban differences in insurance coverage but more research is needed. Source: “How Does Medicaid Affect Insurance Coverage of Rural Populations?” K Thompson, B Kaufman, and M Holmes, North Carolina Rural Health Research Program, July 2014“How Does Medicaid Affect Insurance Coverage of Rural Populations?” Effects of Medicaid Expansion on Rural Areas

7. HRSA Rural O&E Efforts HRSA funding to expand O&E assistance activities: 2013: The Federal Office of Rural Health Policy (FORHP) awarded approximately $1.3 million to 52 Rural Health Care Services Outreach Program grantees. Bureau of Primary Health Care (BPHC) awarded approximately $208 million in supplemental funding to 1,159 health center grantees. 2014: FORHP awarded $1.3 million in supplemental funds to 57 grantees in the Outreach, Quality, and Delta programs. Ongoing efforts: Regular Affordable Care Act webinars with rural grantees and stakeholders O&E materials specific to rural populations Regular conversation with rural grantees around O&E efforts HRSA has made a commitment to outreach and enrollment as an ongoing health center activity by incorporating O&E funding into health centers’ base awards moving forward.

8. FORHP O&E Supplemental Awards: Measuring Impact Total # Outreach Events Conducted Total # Individuals Educated by General Educators Total # of Newly Insured Educated on Benefits Total # Individuals Enrolled Total Additional Funding Leveraged FY 131,11822,887NA9,287$1.3 Million FY 1480912,4234,8594,189$1.3 Million

9. FORHP O&E Technical Assistance Objectives: Ongoing updates and education about the Marketplace. Forum for best practices and strategies in rural. Research dissemination. Dissemination methods: “ORHP, ACA, and You” webinar series. Orhp-acaquestions@hrsa.gov “ORHP, ACA, and You” newsletter.

10. 2015 Rural Enrollment 1,542,970 (17%) of individuals selecting 2015 Marketplace plans were rural residents. Rural enrollment rates in the South lagged behind urban rates. Source: http://www.public-health.uiowa.edu/rupri/publications/policybriefs/2015/FFM%20Enrollment%20Brief.pdfhttp://www.public-health.uiowa.edu/rupri/publications/policybriefs/2015/FFM%20Enrollment%20Brief.pdf Source: http://aspe.hhs.gov/health/reports/2015/MarketPlaceEnrollment/Mar2015/ib_2015mar_enrollment.pdfhttp://aspe.hhs.gov/health/reports/2015/MarketPlaceEnrollment/Mar2015/ib_2015mar_enrollment.pdf Percentage decrease in the number of rural uninsured less than that of urban.

11. 2016 Open Enrollment Rural Outreach Benefits Counseling Program 10 grantees, $750,000 through FY 17 Continued O&E Technical Assistance Rural-relevant research on the Health Insurance Marketplaces

12. Successful Outreach Strategies Leveraging existing community resources. Using local radio, TV ads, and other media to disseminate information about assistance events. Word-of-mouth: encouraging consumers to refer family and friends. Targeting small business owners as partners for information sharing and as venues for events. Reaching out to agents and brokers. Focusing on place-based outreach: Enrolling the community where they “Work, Pray, Play.” Coordinating major outreach efforts with existing seasonal events and venues (e.g., parades, festivals, state fairs, tractor pulls, and back-to-school campaigns).

13. Grantee Story: Little Dixie Community Action Agency Navigator Grant recipient Community Action Agency (CAA) serving 58 of 77 counties in OK Subcontracted to 13 other CAAs Successful O&E strategy: partnering with local schools, faith based communities, and local business to educate community Contact: Chad Austin, Project Coordinator, Oklahoma’s Community Action Agency Navigator Consortium Project, 580.326.6441

14. “ … the need to address financial and other barriers to accessing care, to prevent illness, to ensure adequate nutrition, or to address social, behavioral, and environmental factors that influence health in the community.…” Federal Register: http://www.gpo.gov/fdsys/pkg/FR-2014-12-31/pdf/2014-30525.pdf Not-for-Profit Hospitals can consider doing outreach and enrollment to meet their Community Benefit requirements. Hospitals can enroll children through Medicaid presumptive eligibility. Getting patients into coverage can help improve population health. Also helps improve the hospital’s financial viability. Rural Hospitals: Key Partners

15. Additional HHS partners in O&E Community Health Centers: Around a third of the patients using CHCs are rural residents. Rural Health Clinics: Nearly 3,500 RHCs nationally. Essential Community Providers. 2015 Navigators: 40% of 2015 Navigator awards specified rural populations as a target.

16. Learning from States Certain states were more successful at enrolling eligible rural residents than urban residents in 2015 Health Insurance Marketplace plans. These states include IL, ME, MI, MT, NE, NV, NH, ND, WI, WY. Source: Barker, et. al. “ Rural Enrollment in Health Insurance Marketplaces, by State.” RUPRI Center for Rural Health Policy Analysis. Brief No. 2015-11. October 2015. Retrieved from: http://cph.uiowa.edu/rupri/publications/policybriefs/2015/Rural%20Enrollment%20in%20HIM.pdf http://cph.uiowa.edu/rupri/publications/policybriefs/2015/Rural%20Enrollment%20in%20HIM.pdf

17. Affordability : Financial Assistance through the Marketplace There exist multiple costs associated with insurance coverage: premiums, deductibles, copayments, etc. Premiums have increased. Opportunities often exist for finding more affordable plans Return to the Marketplace!

18. Snapshot of OE3 Enrollment Source: CMS NEWS: Health Insurance Marketplace Open Enrollment Snapshot. Week 3 : November 15, 2015- November 21, 2015 CMS providing weekly snapshots of Marketplace enrollment Comparisons with last year challenging due to open enrollment date change

19. HRSA Affordable Care Act Website o http://www.hrsa.gov/affordablecareact http://www.hrsa.gov/affordablecareact HRSA Office of Rural Health Policy Website o http://www.hrsa.gov/ruralhealth/ http://www.hrsa.gov/ruralhealth/ Office of Rural Health Policy ACA Questions Listserv o orhp-acaquestions@hrsa.gov orhp-acaquestions@hrsa.gov National Advisory Committee on Rural Health and Human Services Policy Brief o http://www.hrsa.gov/advisorycommittees/rural/publications/ruralimplications.pdf http://www.hrsa.gov/advisorycommittees/rural/publications/ruralimplications.pdf Partnering with Community Health Centers on Outreach and Enrollment Resource o http://www.hrsa.gov/affordablecareact/healthcenterpartner.pdf http://www.hrsa.gov/affordablecareact/healthcenterpartner.pdf Marketplace Information and Enrollment o https://www.healthcare.gov/ https://www.healthcare.gov/ Provider and Partner Marketplace Resources o http://marketplace.cms.gov http://marketplace.cms.gov Resources

20. Thank you! Questions? E-mail orhp-acaquestions@hrsa.govorhp-acaquestions@hrsa.gov