1. The Local Health Department’s Role in Healthcare Reform in Washington State Lauren Ho, MPH, CHES Public Health Associate Office for State, Tribal, Local and Territorial Support Centers for Disease Control and Prevention 2015 PHAP Summer Seminar June 2 nd, 2015 Centers for Disease Control and Prevention Office for State, Tribal, Local and Territorial Support

2. The Affordable Care Act  Enacted into law in 2010  Two key goals  Expand health care coverage to uninsured  Slow Down the rising cost of health care  Expands Coverage  Individual Mandate  Expands Medicaid (Washington Apple Health)  Advanced premium tax credits

3. Figure 1.0 taken from http://kff.org/health-reform/state-indicator/state-health-insurance-marketplace-types/#maphttp://kff.org/health-reform/state-indicator/state-health-insurance-marketplace-types/#map

4. Lead Organization Service Areas Figure 2.0 taken from www.wabexchange.org.www.wabexchange.org

5. Affordable Care Act Implementation Lead Organization Model in WA  Build local network of community-based organizations  Focus on target population  Comprehensive work plan  Train Assisters within service area  County-wide mapped outreach plan  Financial agent for network partners  Performance monitoring  Reporting Figure 3.0 taken from www.wahealthplanfinder.org. Figure 4.0 taken from www.hca.wa.gov. Figure 5.0 taken from www.tpchd.org.www.wahealthplanfinder.orgwww.hca.wa.govwww.tpchd.org

6. Pierce County, Washington  One million uninsured in Washington State  100,000 in Pierce county  30,000 eligible for Medicaid Expansion  A quarter of the population needed enrollment assistance  90 percent of newly insured received financial assistance Figure 6.0 taken from www.tpchd.org.www.tpchd.org

7. Target Populations in Pierce County

8. Barriers to Enrollment  Limited health literacy  Minimal English-language proficiency  Inadequate access points for insurance enrollments

9. Uninsured Map Figure 7.0 taken from www.tpchd.org.www.tpchd.org

10. Pierce County IPA Network  Partnerships with 15 community-based organizations (CBOs)  Coordinate outreach, education and enrollment assistance  Trained, certified assisters will provide one-on-one support  In-Person Assister Role  Tailored support with cultural, linguistic, disability or other special needs  Assist, explain, confirm, and facilitate Figure 8.0 and 9.0 taken from www.wabexchange.org.www.wabexchange.org

11. Outreach and Events  Health Fairs  Mall enrollment events  Libraries  Food banks  Utilizing GIS Maps to identify vulnerable populations geographically Figure 10.0 taken from www.tpchd.org.www.tpchd.org

12. Successes  74,469 newly insured residents in Pierce County  300 in-person assisters trained and certified  Tacoma-Pierce County in RAND Corp report

13. Lessons Learned  Building relationships  Tailoring outreach methods  Approaching the next open enrollment with experience and flexibility Figure 11.0 taken from www.wabexchange.org.www.wabexchange.org

14. Future Implications  Local health department to mobilize the boots on the ground for major public health efforts  Life after enrollment  Local health department’s future role in the Affordable Care Act

15. Special Thanks To:  Abstract co-authors Kayla Scrivner and Antoinette Craig  In-Person Assister Program Team  Tacoma-Pierce County Health Department

16. For more information, please contact CDC’s Office for State, Tribal, Local and Territorial Support 4770 Buford Highway NE, Mailstop E-70, Atlanta, GA 30341 Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 E-mail: OSTLTSfeedback@cdc.govWeb: http://www.cdc.gov/stltpublichealthOSTLTSfeedback@cdc.govhttp://www.cdc.gov/stltpublichealth The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Lauren Ho ypc7@cdc.govypc7@cdc.gov (lho@tpchd.org)lho@tpchd.org 253-798-4762 Centers for Disease Control and Prevention Office for State, Tribal, Local and Territorial Support