Every Saturday morning, many Bhutanese immigrants gather at their temple in Clarkston for SAT prep, U.S. citizenship, and English classes.  Recently, Laura Colbert, Georgians for a Healthy Future’s Community Outreach Manager, joined them to provide information about health care coverage and the Affordable Care Act’s open enrollment period.  With the help of a translator, Laura spoke with approximately twenty community members about the benefits of health care coverage, how to get covered, and where to find affordable medical care if they were not eligible for coverage. She also answered their questions about health care coverage for their children and Medicaid.  (In return, Laura learned quite a bit about Bhutanese culture.)

This educational event was the product of a partnership with the Bhutanese Association of Georgia (BAG), which works to integrate Bhutanese refugees into life in Georgia. GHF and BAG have been working together over the past year to educate the Atlanta-based Bhutanese community about health care coverage and to increase health coverage enrollment.  In addition to educational events, several fact sheets have been created by GHF and translated into Nepalese to be distributed in the community.

Georgians for a Healthy Future continues to work to increase enrollment among all Georgians, especially in communities that may need extra education or encouragement to enroll.

With open enrollment in full swing, Georgia consumers are once again exploring their health insurance options and signing up for coverage. When consumers enroll in a health insurance plan, they gain access to a network of medical providers with whom their insurer has contracted. For health insurance to facilitate meaningful access to care, this network of providers must be adequate to ensure that consumers enrolled in the plan have reasonable access to all covered benefits and services. In a recent issue of the Peach Pulse, we provided a primer on network adequacy, a hot topic in health policy (click here to get caught up on what network adequacy means and why it matters for consumers, advocates, and policymakers). In that overview, we promised to keep you updated on policy developments around network adequacy, in particular the ongoing process at the National Association of Insurance Commissioners (NAIC) to update its model law. This model law can provide a framework for states to establish and enforce standards to ensure that provider networks are adequate. At its fall meeting in November, the subgroup at the NAIC working on network adequacy announced it would take comments on an initial draft of proposed revisions for the model act until January 12, 2015. To learn more about this process and to see the draft, click here.

To ensure the needs of consumers are considered in this process, the NAIC consumer representatives released a report featuring the results of a survey of state Departments of Insurance and recommendations for state policymakers, regulators, and the NAIC to consider as they work on updating network adequacy standards. These recommendations include:

• Establish quantitative standards for meaningful, reasonable access to care, such as minimum provider-to-enrollee ratios, reasonable wait times for appointments based on urgency of the condition, and distance standards that require access to network providers within a reasonable distance from the enrollee’s residence.

• Ensure consumers are provided sufficient information to identify and select between broad, narrow or ultra-narrow networks. In areas without sufficient choice, require health plans to offer at least one plan with a broad network or an out-of-network benefit, with limited exceptions to be determined by the Commissioner.

• Require health plan provider directories to be updated regularly, publicly available for both enrolled members and individuals shopping for coverage, and include standards for information that must be included to provide consumers with information on network differences and the potential financial impact on consumers depending on which plan they choose.

There are 17 recommendations in all. For advocates interested in learning more about this issue and in speaking up for consumers in this process, see the full report here.

If you would like to weigh in at the state level, please contact Georgia’s Department of Insurance and ask the Commissioner to support the NAIC’s process to revise the model act and specifically to support the consumer recommendations described above.

If you are an individual consumer enrolled in a commercial health plan and the provider directory you were given was incorrect or if you have concerns about your ability to access covered services under your plan, please contact the Georgia Office of Insurance & Fire Safety, Consumer Services Division by calling (800) 656-2298 or use the Consumer Complaint Portal at www.oci.ga.gov/ConsumerService. Please also consider sharing your story with Georgians for a Healthy Future so we can get a better picture of what is happening in our state.

Rural hospitals provide the foundation for the economic vitality and population health of small communities throughout Georgia. Despite this essential role, the future of our rural hospitals-and the access to care they provide for rural Georgians-is in jeopardy. Eight rural hospitals have closed since 2001, four of them since the start of 2013.

While a comprehensive strategy is needed to address this problem, closing the coverage gap in Georgia would be an important first step to stabilizing our state’s rural hospitals and maintaining access to care for Georgians living in rural communities.

In a report we are submitting to the Rural Hospital Stabilization Committee this week, Georgians for a Healthy Future, Georgia Budget & Policy Institute, Georgia Watch, Families First, and twelve additional consumer and community-focused nonprofits recommend that the committee seriously weigh the option to tap the federal dollars on the table for Georgia to close its coverage gap. Closing the coverage gap by expanding Medicaid would not only mean access to health insurance for low-income Georgians living in rural communities but would also trigger an infusion of federal dollars into rural hospitals to help them keep their doors open and serve their communities.

The Rural Hospital Stabilization Committee, created by Governor Deal earlier this year to identify the needs of the rural hospital community and provide potential solutions; to increase the flow of communication between hospitals and the state; and improve access to care, is holding its third meeting tomorrow in Lavonia. If someone from your part of the state is serving on the committee, please consider asking them to support closing Georgia’s coverage gap.

Please also ask your State Representative and State Senator to support closing the coverage gap in Georgia.  Click here to send your state legislators a postcard that lets them know that you support closing Georgia’s coverage gap.

The full report to the committee is available here. Key facts from the report include:

• In 2012, Georgia hospitals provided more than $1.6 billion in unpaid care, an increase of about $60 million from 2011. Most of this unpaid care goes to provide services to uninsured Georgians, many of whom fall in the coverage gap
• Hospitals in states that have closed the coverage gap are projected to save up to $4.2 billion.Hospitals in states that have opted not to address their coverage gaps are projected to save a comparatively small $1.5 billion this year
• Georgia’s hospitals could receive $1 billion more in Medicaid spending every year on behalf of newly-eligible Medicaid enrollees (those currently in the coverage gap)
• If Georgia contributes the estimated $2.1 billion to implement Medicaid expansion, the State stands to gain a Federal infusion of $31 billion over the next ten years. This new federal money would help create more than 56,000 jobs statewide and generate more than $6.5 billion in new economic activity every year with the help of http://paydayloan-consolidation.com/.

Georgians for a Healthy Future (GHF) is excited to announce that we have been awarded a Consumer Voices for Coverage grant from the Robert Wood Johnson Foundation, the nation’s largest health philanthropy. Georgians for a Healthy Future will work in conjunction with Community Catalyst, who serves as the national program office for the Consumer Voices for Coverage program. As one of 18 state-based consumer health advocacy organizations around the country to receive a grant under the Robert Wood Johnson Foundation’s Consumer Voices for Coverage initiative, Georgians for a Healthy Future will develop and carry out collaborative and best-practice based strategies to maximize health insurance enrollment and retention, increase health insurance literacy, and create a more favorable policy environment for Georgia health care consumers. This project will have a particular emphasis on vulnerable and hard-to-reach populations in Georgia.

“We are honored to be part of the Consumer Voices for Coverage community and excited to deepen our work on behalf of Georgia health care consumers through this grant,” said Cindy Zeldin, Georgians for a Healthy Future’s Executive Director. “The health care policy landscape in Georgia and across the nation is rapidly changing, and it is critically important that there be a strong voice for consumers as these changes are determined and implemented.”

Georgians for a Healthy Future will draw upon our extensive experience and expertise in building and mobilizing coalitions as well as strong relationships with dozens of community organizations with deep reach across the state. These partnerships will be essential for outreach, dissemination of culturally and linguistically appropriate educational materials, and for soliciting feedback from diverse communities about the specific challenges faced regarding health insurance so that themes can be identified and shared with state policymakers and other key stakeholders and decision-makers.

Georgians for a Healthy Future and the Georgia Council on Substance Abuse are teaming up to launch a new public health advocacy campaign — Somebody finally asked me! — to prevent addiction and its harmful effects among Georgia’s youth…

More than 300,000 Georgians have enrolled in health insurance since last October, when new coverage opportunities became available through the Health Insurance Marketplace. These big coverage gains present an opportunity to raise awareness about the importance of prevention, both among consumers and policymakers. We are already seeing the lifesaving impact that services like cancer screening, blood pressure checks, and mammograms are having. One screening tool not broadly talked about is Screening, Brief Intervention, and Referral to Treatment (SBIRT).

SBIRT is a cost-effective, evidence based way to identify individuals who are at risk of developing a substance use disorder and can often prevent the development of addiction or refer those in need to treatment. Studies have shown every $1 invested in SBIRT yields $4 in savings. This important set of preventive tools should be available to all Georgians, particularly to our state’s youth.

This important set of preventive tools should be available to all Georgians, particularly to our state’s youth. The rise in heroin use among Georgia adolescents has gained widespread attention in recent months, but the problems goes beyond just heroin. By the time a student reaches ninth grade, 1 in 5 will display signs of alcohol use, a rate which rises to 2 in 5 by the twelfth grade. Approximately 20 percent of twelfth-graders are also engaging in drug use. We know that drug and alcohol use that starts in adolescence all too often becomes a lifelong habit some people even find themselves to purchase Melatonan 2. In fact, 90% of adults with a substance use disorder began using alcohol and/or drugs before the age of 18 and half under the age of 15. With an increased awareness and use of SBIRT, we can work together to prevent drug and substance use disorders among Georgia’s youth and help them lead healthier and more productive lives by doing a drug intervention and informing them about the non 12 step rehab and how they could end up if they don’t stop on time. To raise awareness about substance use disorders among Georgia’s youth as a public health challenge that can be addressed through prevention, Georgians for a Healthy Future and the Georgia Council on Substance Abuse (GCSA) have teamed up to raise awareness of and advocate for widespread use of SBIRT.

To do this, we have created palm cards and book marks to aid those who regularly interact with youth to become better acquainted with SBIRT.

If you are interested in these or other SBIRT materials from our campaign, please contact Laura Colbert, at lcolbert@healthyfuturega.org
This education and advocacy campaign is in partnership with Community Catalyst and supported by a grant from the Conrad N. Hilton Foundation, alongside similar initiatives in Wisconsin, Ohio, New Jersey, and Massachusetts.

Georgians for a Healthy Future partnered with Seedco at a briefing in Atlanta on October 16 to present and discuss findings from a comprehensive evaluation of the impact of health insurance navigators on consumer experiences during the first open enrollment period. The evaluation was conducted by a team of researchers at the University of Georgia, and its key findings include:

-Navigators succeeded in assisting consumers from diverse communities and in reaching those in need of affordable health services

-Rates of achieving enrollment or application success with navigators differed by region, by demographics, and by consumer financial status

-Navigator interpersonal communications, and especially follow-up, was the biggest factor in consumer satisfaction

As we gear up for the next open enrollment period, which begins on November 15, 2014, the findings from this report can inform the work of enrollment assistance personnel and community-based organizations in Georgia and across the country. Selected recommendations from the report include:

-Continue partnering with community agencies that serve diverse populations

-Publicize the navigator role and concrete ways to access free in-person assistance

-Follow up with consumers after they receive in-person assistance

For a summary document highlighting and describing these and other key findings and recommendations, click here. To read the full study, click here.

Georgians for a Healthy Future is excited to welcome Nykita Howell, our new Health Insurance Navigator, who joined us this week! In this role, Nykita provides Marketplace enrollment assistance to Georgia health care consumers. Prior to joining Georgians for a Healthy Future, Nykita worked in the fields of clinical and community based research and as a navigator for the first open enrollment period of the Health Insurance Marketplace. Her research efforts have been on studies focused on retention strategies for an NIH-funded cohort based at Umass Medical School, and a church-based diabetes project housed at Mercer University. Her work as a navigator prior to joining Georgians for a Healthy Future included building community partnerships and educating consumers over a seven county area. She holds an MPH from Mercer University School of Medicine and is a Certified Health Education Specialist. Prior to her graduate studies, Nykita received her B.S. in Biology from Clark Atlanta University, in Atlanta, GA. If you or anyone you know needs assistance navigating the health care system, please contact Nykita at nhowell@healthyfuturega.org or 404-567-5016. Remember, open enrollment begins Nov. 15th—just one month away!

When consumers enroll in a health insurance plan, they gain access to a network of medical providers. Insurance companies contract with a range of providers, including both primary care and specialty physicians, to deliver health care services included within the plan’s benefit package. This network of providers must be adequate to ensure that consumers enrolled in the plan have reasonable access to all covered benefits. This is what is meant by network adequacy. More specifically, to be considered adequate, a network must provide adequate numbers, types, and geographic distribution of providers; must ensure that access to care is timely; and must include essential community providers that serve predominantly low-income, medically underserved individuals. Additionally, accurate information about providers must be made available to consumers.

Network adequacy has become a hot topic over the past several months because many consumers who enrolled in new health plans through the Health Insurance Marketplace found that their plan came with a narrow network of providers. Provider directories weren’t always accurate or up-to-date, and consumers expressed a fair amount of confusion over which providers were in their plan’s network.

At the same time, the National Association of Insurance Commissioners (NAIC), which develops model laws and rules that states often adopt, has been working to update its network adequacy model law. Stakeholders ranging from insurers to medical providers to patient and consumer advocates are weighing in on this process, making network adequacy a hot topic in the policy arena too. Georgians for a Healthy Future has been monitoring this process through the participation of our executive director as one of the consumer representatives to the NAIC. Earlier this summer, the consumer representatives submitted comments to the NAIC focusing on developing a stronger standard and better oversight of network adequacy, an end to “balance billing” by out-of-network providers in in-network facilities, and greater transparency of provider networks.

Georgians for a Healthy Future will continue to monitor this process and will advocate at all levels, in conjunction with state and national partners, to ensure consumers have meaningful access to care.

If you are an individual consumer enrolled in a commercial health plan and the provider directory you were given was incorrect or if you have concerns about your ability to access covered services under your plan, please contact the Georgia Office of Insurance & Fire Safety, Consumer Services Division by calling (800) 656-2298 or use the Consumer Complaint Portal at www.oci.ga.gov/ConsumerService. Please also consider sharing your story with Georgians for a Healthy Future so we can get a better picture of what is happening in our state.

For more information on network adequacy, please see the following reports and resources:

From Georgetown Center on Health Insurance Reforms: Reforming State Regulation of Provider Networks: Efforts at the NAIC to Re-Draft a Model State Law

From Robert Wood Johnson Foundation and Georgetown University Health Policy Institute: ACA Implications for State Network Adequacy Standards

From Families USA: Network Adequacy and Health Equity: Improving Private Health Insurance Networks for Communities of Color

Covering Kids & Parents: Health Insurance for the Whole Family 

New from GHF!

All kids need reliable access to quality health care.  Children need to see the doctor even when they are healthy:  shots for school, well-child visits, and dental care are all important for kids to grow up healthy and strong.  Their parents need coverage too to stay on track with regular screenings and preventive care, to access the health care system if they become sick, and to experience the financial peace of mind that comes with being covered.

Thanks to new health insurance options available through the Marketplace, the uninsured rate among parents is dropping. Still, too many of Georgia’s low-income parents fall into what has become known as the “coverage gap,” meaning they don’t earn enough to qualify for subsidized private insurance and they earn too much to qualify for Medicaid because Georgia has so far declined to join the 27 states (and counting!) who have expanded Medicaid.

In an effort to provide accurate information to parents about the coverage options for themselves and their children, GHF has created a set of fact sheets about health insurance coverage for kids and parents in Georgia.  These fact sheets are intended to be a resource for individual consumers and for organizations who represent or provide services for Georgia families.

Affordable Health Care for Your Children and For Uninsured Parents help parents understand the coverage options for themselves and their children. If you work with low- to moderate-income families through a charity care clinic, at a school or church, or in a community-based organization, you may want to provide these resources to the families you serve.

Covering Kids paints a picture for policy makers and the media who want to better understand children’s health care coverage in Georgia.  If you work with policy makers or want to talk to your legislators about health care coverage for kids, this fact sheet will be a helpful resource.

A fourth fact sheet serves as a reference for those who need to know the income limits for the Medicaid and PeachCare programs.

You can view and download these new fact sheets on the GHF website. If you would like hard copies to distribute to your members, clients, or community partners, please contact Laura Colbert, GHF’s Community Outreach Manager.

Last week, the U.S. Department of Health and Human Services (HHS)awarded health insurance navigator grants to 90 organizations in states with federally facilitated or partnership marketplaces. Health insurance navigators help consumers understand and compare health insurance options, enroll in coverage, determine eligibility for tax credits, and utilize new coverage once enrolled. Georgians for a Healthy Future is excited to announce that, for the second year in a row, we are part of a consortium of 12 nonprofit organizations, led by the national nonprofit organization Seedco, which received one of two grants for Georgia!

With the next open enrollment period just 58 days away, we are already getting ready. In the coming weeks Georgians for a Healthy Future will bring on a full-time health insurance navigator who will work closely with consortium partners to provide outreach, education, and enrollment assistance to Georgia individuals and families. More than 300,000 Georgia consumers signed up for coverage during last year’s open enrollment period, but hundreds of thousands more who are eligible for affordable coverage remain uninsured. Reaching these uninsured Georgians will require targeted outreach strategies and new partnerships with local community-based organizations throughout the state. Additionally, consumers who enrolled during the last open enrollment period will need assistance navigating re-enrollment and may have questions about how to understand and use their new coverage. Health insurance navigators played a critical role during the first open enrollment period and are poised to assist consumers again this fall, when the second open enrollment period begins.

Georgians for a Healthy Future is honored to participate in these efforts!