Affordable Care Act (ACA) Learning Sessions for Social Sector Leaders & Community Advocates August 17, 2012 Coordinated by Access HealthColumbus Community Advisory Committee Purpose Spread knowledge of federal health care reform in non-profit organizations to improve their ability to serve clients during the implementation of the Accountable Care Act (ACA). Today’s Objectives 1. Improve knowledge on the value of: • American Health Benefits Exchanges • Navigators intended to personally assist consumers in understanding their choices and selecting insurance coverage 2. Inventory learning on barriers encountered when reaching out to vulnerable people
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August: ACA Learning Session on Exchange, and Navigators
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Affordable Care Act (ACA) Learning Sessions for Social Sector Leaders & Community Advocates
August 17, 2012
Coordinated by Access HealthColumbus Community Advisory Committee
Purpose Spread knowledge of federal health care reform in non-profit organizations to improve their ability to serve clients during the implementation of the Accountable Care Act (ACA). Today’s Objectives 1. Improve knowledge on the value of:
• American Health Benefits Exchanges • Navigators intended to personally assist consumers in understanding their
choices and selecting insurance coverage 2. Inventory learning on barriers encountered when reaching out to vulnerable people
Affordable Care Act
Near Universal Insurance Coverage
Guaranteed Issue &
Insurance Mandate
Improvement Programs
(and grants)
Health Benefit
Exchanges
Expansion of Medicaid
Subsidized commercial
insurance for middle-income
families (market based)
Source: Supreme Court Policy Brief, Health Policy Institute of Ohio, July 2012, http://bit.ly/SjDBca
The Enroll UX 2014 design offers a new standard for public and private health insurance enrollment, and serves as a reference model for a first-class user experience (UX) design for health insurance exchanges.
Massachusetts Health Connector
UHCAN Ohio is a statewide nonprofit organization working for high quality, accessible, affordable health care for all Ohioans.
Navigators in the New Health Benefits Exchange
How to create a strong navigator program for our communities
Cathy Levine Executive Director, UHCAN Ohio
UHCAN Ohio is a statewide nonprofit organization working for high quality, accessible, affordable health care for all Ohioans.
Why do we need Navigators in the Exchange?
• Up to 1.5 million uninsured Ohioans
• Many do not know they have new options for getting affordable coverage in 2014
• Many do not know how insurance works – how to shop for insurance
• Many will not know about the Exchange or how it works
• Many will not have access to computer
UHCAN Ohio is a statewide nonprofit organization working for high quality, accessible, affordable health care for all Ohioans.
What is a Navigator?
• A guide to help you get where
you need to go.
• The ACA created a Navigator
function to – Inform people about their new insurance options
– Help people enroll in their plan of choice
– Help people keep their coverage (stay enrolled)
• The Navigator does not choose a plan or influence the choice of a plan.
UHCAN Ohio is a statewide nonprofit organization working for high quality, accessible, affordable health care for all Ohioans.
Need for Community-Based Navigators
• Consumer or community-focused non-profits
• Licensed insurance agents and brokers
• Industry, trade, professional associations
• Unions
• Chambers of commerce, small
business groups
• Commercial fishing industry
organizations
• Farming and ranching organizations
• Others to reach specific populations
UHCAN Ohio is a statewide nonprofit organization working for high quality, accessible, affordable health care for all Ohioans.
Duties of Navigator According to ACA • Conduct public education activities about what’s
available
• Distribute impartial information about
plan enrollment and availability of tax
credits
• Help people enroll in “qualified health plans”
• Provide referrals for people with complaints and questions about their health plan
• Provide information in culturally, linguistically appropriate manner for populations served
UHCAN Ohio is a statewide nonprofit organization working for high quality, accessible, affordable health care for all Ohioans.
Consumer Protections through Navigators
• Navigators must receive no direct or indirect payments from health insurers
• Insurers are explicitly prohibited from being navigators.
• Therefore, navigators are funded through grants provided by Exchange funds.
UHCAN Ohio is a statewide nonprofit organization working for high quality, accessible, affordable health care for all Ohioans.
Who will enroll in Exchange? From Congressional Budget Office study
• More than 1/3 haven’t had check-up and will have had difficulty accessing care
• Because of tax credits, most will have lower incomes than today’s privately insured
• More racially diverse than currently insured
• 77% will have high school diploma or less
• Languages other than English
• Majority will have been previously uninsured
UHCAN Ohio is a statewide nonprofit organization working for high quality, accessible, affordable health care for all Ohioans.
Features of Strong Navigators
• Training in Exchange, Medicaid, public programs and private insurance market
• Ability to explain eligibility, benefits, cost-sharing, appeals processes to consumers
• Have community’s trust to provide correct, clear information
• Act in interests of consumer, not insurers
• Ability to reach hard-to-reach, poor people
• Ability to explain tax-credits and financial impact
• Represent diverse organizations to serve diverse people eligible for insurance through Exchange
UHCAN Ohio is a statewide nonprofit organization working for high quality, accessible, affordable health care for all Ohioans.
Under Federal Exchange, How is the Navigator program created?
• Ohio could request to have a “partnership” – allows Ohio to run Navigator program
• Otherwise, federal exchange issues requests for proposals from entities to navigate
• How does it all come together?
– Still many unanswered questions
– Community groups have to organize
themselves to participate in meaningful way
UHCAN Ohio is a statewide nonprofit organization working for high quality, accessible, affordable health care for all Ohioans.
What’s Next?
• UHCAN Ohio is tracking NAIC, federal regulations
• Community organizations need to figure out what role they want to play develop joint proposals
• Role of Ohio Benefit Bank? United Way? Other big players?
• UHCAN Ohio will host phone calls,
live meetings to facilitate
coordination and participation
from diverse communities
UHCAN Ohio is a statewide nonprofit organization working for high quality, accessible, affordable health care for all Ohioans.
Interested in Further Discussions and Information?
• Sign up for our navigation email list
• Call us to do presentations and lead discussions for groups you convene