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Last night's Tuesday Night Policy Call featured Jessica Kendall of Enroll America and Beth Heeb, Executive Director of Consumer Health Coalition who discussed how advocates and community organizations can be helping Pennsylvania to prepare for The Big Day.
By The Big Day I'm obviously referring to October 1st, 2013 when uninsured Pennsylvanians and small business owners will be able to purchase health insurance through the new marketplace (likely with the help of subsidies). When the new health care law was originally passed in 2010, this day seemed terribly out of reach. Now, as Pennsylvania scrambles to get ready, we're joined by two experts that can give us a state and national perspective on what needs to happen next.
In this blog post you'll find a summary of Enrolling Pennsylvania. To really benefit from the information presented, it's encouraged that you listen to the call via the link below. (I know, it's a long post, but it's still not nearly everything..)
Our first guest, Jessica Kendall of Enroll America:
Enroll America is working to ensure Americans get enrolled and stay enrolled in the insurance that will now be available over the next year. Jessica talks to us about some of the challenges nationally and what Enroll America (and other national organizations) are doing to meet those.
They've put together a Best Practices Institute to see what's worked in the past, what hasn't, and what lessons we can take for enrollment in the marketplaces.
Jessica goes on to give us some background:
In Pennsylvania 1.3 million uninsured will be eligible for coverage through the Medicaid expansion or marketplace and for most of them this will be the first opportunity they have for coverage. They can apply through various portals: via the phone, paper application, online, fax, but it should be a seamless process.
Online is the most consumer friendly process where they fill out certain questions and at the end you see 'apples to apples' comparisons of plans without fine print that they can enroll into.
Then she tells us the biggest barrier:
Between 78-83% of people that could enroll into coverage through the new marketplace or expanded Medicaid have no idea this options are coming to them. (YIKES!) The same survey found people overwhelmingly want this once they learned about it and 3 out of 4 of them want in-person help to enroll.
Regarding the navigator grants:
In Pennsylvania where we have a federally facilitated marketplace, there will be 2 entities that will be awarded navigator grants issued from the Federal Government and due June 7th. Goal of grants is for entities to do outreach, public education to reach uninsured folks and to help them with the application in a culturally and linguistically competent manner.
Regardless of number of navigator grants awarded, 1.3 million uninsured, so reaching all those folks will take MORE than just people that receive navigator grants, it's going to take “all hands on decks.”
Get Covered America:
Getcoveredamerica.org to sign up for updates and track what's happening. Enroll America is also working on paid media, earned media, and other ways to help with the education piece, like grassroots organizing.
There are also funding streams to do navigation and assistance, but spreading the word is the most valuable thing partner organizations can do!
Next up: Beth Heeb, Consumer Health Coalition
A little background from Beth:
CHC is a 15 yr old nonprofit healthcare advocacy organization located in Pittsburgh whose mission is to ensure access to quality affordable healthcare. They accomplish this by enrolling eligible individuals in public health insurance programs through a free helpline. They focus on vulnerable populations which they define as individuals with low income, people with disabilities, individuals from racial and ethnic minority backgrounds. To identify eligible uninsured they conduct regular outreach and education throughout South Western Pennsylvania.
Beth joined us to give us an overview of how CHC does their outreach, their best practices, strategy, challenges, and anything else they can tell us to help us prepare for The Big Day.
Before they begin any outreach effort they work to best analyze the area they intend to work in and then design a strategy that will best reach target population. She listed off things they look at like: who are the uninsured, what ethnicity are they, languages, education level, where do they live, etc.. An example: After conducting this type of research it is discovered that the area they want to focus in is: rural, with a large Hispanic population that speaks limited English, it is expected many people here have children eligible for CHIP or MA, there is a church that many of these consumer attend because mass is often in Spanish. CHC then sent their Spanish speaking staff member to meet with church leadership and see how they could work together to ensure children were enrolled into programs for which they were eligible.
Beth then gave participants an overview of where PA's uninsured are:
1.3 million in the state and top 10 uninsured counties are: Delaware, Chester, Montgomery, Bucks, York, Lancaster, Berks, Lehigh, Philadelphia, and Allegheny. 87% of uninsured folks in Pennsylvania make less than 400% of the federal poverty level. 38% of the uninsured make less than 138% (Medicaid expansion eligible) and for this population specifically, Chester county drops to 11th in the state and Luzerne county enters among top ten with highest uninsured rate that would be eligible for Medicaid expansion. Beth went on to talk about what it means that the majority of these counties are rural, and broke down for us the uninsured by ages, races, languages they speak, gender, and more.
CHC outreach strategies:
CHC has been doing outreach and education in SWPA for 15 years and have tried “absolutely everything” to find and enroll uninsured individuals. Identified a few practices they found more successful than others.
The pledge program:
100% pledge program – with an organization that signs a formal pledge committing them to work with CHC. Train their staff on programs that their population would benefit from. Pledge they sign promises they will ask everyone that comes through their doors they will ask everyone who comes through their doors if they have health insurance. If the person doesn't have insurance then the pledge partner either enrolls the knowledge they gained from a CHC training or they refer them to CHC. The majority of CHC's pledge partners (they have over 100) refer clients for enrollment. 65% of CHC's clients come from pledge partners.
Why pledge program is successful:
It's easy. Ask “do you have insurance?” then make a referral.
Increases capacity of staff at partner sites through training CHC provides for free.
Trust factor: client trusts CHC now because referred to by someone they trust. Very important especially when dealing with mixed status families.
What you should be aware of before considering pledge partner program:
Must be prepared to conduct regular follow-up training with partners (staff turnover, programs change).
Must be sensitive to other cultures, best to hire someone from the community you're trying to reach.
Difficult to track number of people served by the partners if they enroll folks themselves after you've trained them.
There's drop-off with referrals.
Other strategies – Conducting General Outreach
Beth quickly highlighted a few things to be aware of when conducting general outreach (like tabling at a health fair):
Hit or miss. Generally community outreach hasn't lead to a significant number of enrollments especially compared to time spent.
Requires diligent tracking to see if time spent it yielding results.
CHC receives about 15% of clients through that, though it will work better most likely for open enrollment because income guidelines will be broader.
What to consider:
Demographic you're trying to reach.
Look for established events with reputation for turning folks out.
That you're sending the right staffperson.
CHC's recommendations for groups to target for outreach:
United Ways, clinics, community centers, Health Department, Events hosted by county departments, hospitals and social workers, churches, community based organizations that specialize in serving your demographic – SNAP organizations, WIC, Child care centers; hair salons, etc. Think outside the box. (Or listen below for even more ideas..)
Recommendations for rural areas:
CHC has had a lot of luck working with United Way. Rural area is going to mean lots of travel and follow-up especially if you're not located in that area. You need to take time to understand the community and adjust the cost per enrollee.
PHAN's Enrollment Committee:
Within the past few months PHAN has established an enrollment committee chaired by Beth. The committee is currently in the process of exploring how PHAN partners can maximize enrollment, taking an inventory to see who does enrollment, who takes trainings, etc. and what resources partners need from PHAN to help facilitate enrollment. After finished taking inventory, the committee will develop an implementation plan based on the results of the survey. Everyone who is interested in participating is welcome to join – email Antoinette at firstname.lastname@example.org.