Getting Ready for the Expansion of Coverage in 2014 Presentation for Texas CHIP Coalition June 15th, 2012 Ani Fete, Director of State Assistance Martine Apodaca, Director of Public Education America.org 1

Goals for Today’s Presentation 2 1. Learn about Enroll America and how we hope to support state enrollment efforts. 2. Understand the policy options Enroll America promotes to simplify and streamline enrollment. 3. Discuss outreach planning needs in Texas and identify at least one step your state can take this year to get ready.

About Enroll America 3 Diverse Partners: Consumer groups Insurance companies and health plans Hospitals and community health centers Providers The Rx industry Civic organizations Organizations representing communities of color Many more Two-fold strategy: Promoting Best Practices Raising Public Awareness Mission: ensure that all Americans get enrolled – and stay enrolled – in health coverage.

Raising Public Awareness : We will launch a national public education campaign to inform Americans about the benefits of health coverage and their rights and obligations under the Affordable Care Act (ACA). The goals of this campaign will be: 1. Develop a sophisticated national data and research-driven advertising campaign; 2. Supplement and enhance state-based public education and outreach work; 3. Create national and state partnerships to amplify enrollment messages; and 4. Recruit, train and utilize corporate and celebrity partners.

How Do We Get There? We specifically want to know: (1) what are the most effective messages to reach different demographic and geographic groups; (2) who are the best messengers for these communications and (3) what are the best means of reaching the groups (e.g. television, radio, social media, etc.) Enroll America will hire a firm to conduct extensive market and consumer research.

How will people APPLY for coverage? Online? By phone? On paper? Available in the right languages? Written in plain language? Accessible for people with disabilities? What SYSTEMS will need to be developed to make it possible? Consumer-friendly “front end” “Back end” systems that are coordinated between Medicaid, the Exchange, CHIP, other programs Connections with data that can help prove eligibility What ASSISTANCE will they need? Understanding the application and eligibility process Counseling on tax credit decisions Help choosing a plan and learning how to use it How can people KEEP coverage once they’ve got it? Data-driven renewal No need to return forms Opportunities to update information and change coverage as circumstances change

Health Coverage in Income as a percent of the federal poverty level Coverage Options for Adults without Medicare or Employer-Based Coverage A Continuum of Coverage – Everyone Fits Somewhere!

The 2014 Enrollment Challenge 8 Source: March 2012 CBO estimates Millions Enroll at least 21 million people in new coverage options } 8 million in Exchange coverage 13 million in Medicaid or CHIP }

The Enrollment Challenge in Texas 6.1 million non-elderly uninsured Over half likely Medicaid eligible (54 %) 38% eligible for exchange coverage with premium tax credit 8% eligible for exchange w/out tax credit Source: March 2010 and 2011 Current Population Survey

Data-driven Renewal for Continuous Coverage Online Tool for Consumers to Easily Compare and Enroll in Health Plans Modern, Data-driven Verification Systems “No Wrong Door” Eligibility and Enrollment Model Simple, Streamlined Application A New Way to Enroll in Coverage

Single, Streamlined Application Now Different applications for different programs Denied? Back to the drawing board Applications often only available on paper or as PDFs if online In-person interview requirements 2014 Regulations require a single application as gateway to all coverage programs Must be available online, by telephone through a call center, by mail, and in person Interview requirements prohibited 11

UX 2014 – Model Application Behavioral segmentation to design a system that is responsive to people’s different needs, desires, and expectations.

“No Wrong Door” Consumers can connect to whichever program they are eligible for, no matter where they start. 14 Complete single application Determine eligibility Enrolled in correct program! Medicaid CHIP Exchange Medicaid CHIP Exchange

Data-driven Verification System Now Assumed ineligible until proven otherwise Onerous paper documentation burden: pay stubs, birth certificate, proof of residency, etc. Asset tests common 2014 Real-time, electronic verification to the greatest extent possible Must use federal electronic service (“data hub”) Reasonable Compatibility standard Attestation allowed for most elements Paper documentation requirements prohibited if data available electronically Asset tests not permitted

Renewals – Medicaid and CHIP Now Renew every few months Submit new paperwork to prove eligibility Pre-populated forms, passive renewal in some states, mostly for kids 2014 Redetermine every 12 months Data-driven, without requiring applicant to sign or return a form, if possible If not possible, send enrollee pre-populated form and allow 30 days to return Enrollees must report changes that could affect eligibility

Renewals - Exchange Now N/A 2014 Exchange sends annual redetermination notice with projected eligibility for coming year Enrollee has 30 days to report changes If notice is not returned, exchange makes redetermination based on their projection Enrollees must report changes that could affect eligibility

But open enrollment doesn’t start until October 1, What can be done right now to promote enrollment?

7 Concrete Steps for Take advantage of federal funding. 2. Develop an outreach plan. 3. Automate enrollment for early gains. 4. Minimize documentation requirements. 5. Promote data-driven eligibility systems. 6. Redouble efforts on consumer assistance. 7. Make materials easy to read and understand.

Sources of Federal Funding 20 Medicaid 90/10 Eligibility and claims systems upgrades Must meet 7 criteria, including seamless coordination with an exchange Available through 12/15 75% match for operations and maintenance Exchange Establishment Grants Activities related to creating an exchange (11 core areas, including stakeholder consultation, program integration, Exchange IT systems, providing assistance to individuals and small businesses) Available through 1/1/15 Level I and Level II

Federal Funding 21 Medicaid 90/10 match Alaska: Applied to use 90/10 Hawaii: Using 90/10 Source: Performing Under Pressure: Annual Findings of A 50-State Survey of Eligibility, Enrollment, Renewal, and Cost- Sharing Policies in Medicaid and CHIP, , Kaiser Family Foundation, January Key Using 90/10 Applied to use 90/10 Plan to apply this year Not using/no plans

Federal Funding 22 Exchange Establishment Grants as of May 15, 2012 Alaska: No Hawaii: Yes Key No grant One Level I grant received Multiple Level I grants Level II grant received

Collaboration: A Key to Success 23 Sharing Resources Sharing Information Planning Together Whether it’s policy implementation or outreach planning, both are most successfully driven by collaboration across government, nonprofit, and corporate sectors.

State Assistance 24 Engaging national partners at the state level; Generate materials for state stakeholders to replicate and use; Share national public education campaign resources; Outreach and enrollment assistance and toolbox; Enhance communication and sharing within/between states; Coordinate approaches to funders; Assist with organizing and providing support to state collaborations for outreach, enrollment, and retention initiatives.

Sharing from Other States 25 Building/Strengthening Coalitions Encouraging adoption of best practices for enrollment and retention at the state level Maintaining a website to enhance communications with links to enrollment channels Planning and implementing outreach,enrollment, and retention initiatives

Discussion

Thank you! Martine Apodaca Director, Public Education Ani Fete Director, State Assistance 27