"These gaps really make it so that Georgians can't afford needed health care. If they receive health care, they're left with medical debt, or they have to make really tough…
GHF conducted in-depth interviews with and survey of enrollment assisters across the state to identify best practices and lessons learned from open enrollment 2. Here’s a summary of what worked, what didn’t, and what we can improve on next year.
What worked during OE 2: Successful strategies and best practices
Using a variety of local venues to conduct extensive outreach. Across the board, enrollment assisters identified the importance of conducting a broad range of outreach and enrollment activities at the local level. They identified a variety of venues where they successfully reached consumers including libraries, churches, college campuses, Volunteer Income Tax Assistance (VITA) sites, doctor’s offices, community health centers, cooperative extension offices, small businesses, AIDS service organizations, and local hospitals. For example, one navigator organization worked with a nurse navigator who met with uninsured consumers who presented at the emergency room at the local hospital. The nurse navigator connected these uninsured consumers to a navigator organization, allowing the organization to reach a much larger pool of consumers than if they had not had this partnership. Enroll America also provided significant support to assisters’ outreach and enrollment efforts. Assisters were limited in their ability to retain personal information about consumers, but because Enroll America only provided outreach and education, they could retain contact information and follow up with consumers seeking more information about the Marketplace.
Leveraging the support of existing partnerships for outreach. All of the assisters interviewed acknowledged that one of their best methods for reaching consumers was building upon existing relationships with community organizations. One group wrote letters to community partners letting them know of their navigator services, which created more awareness in their communities. Another enrollment assister organization had deep ties with Family Connection Partnership organizations in their area, which allowed them to have a well-known partner in each of the counties that they covered.
These partnerships allowed the enrollment assister organizations to use existing frameworks of community organizations to educate and provide enrollment assistance to the populations served by these groups. Because of the strong presence and history these partner organizations have in the communities they serve, consumers also viewed them as credible.
Developing trust with consumers. One of the most critical aspects of providing enrollment assistance was for assisters, and their organizations, to be recognized as a trusted resource within their communities. This was especially true for assisters working with immigrant and non-English speaking populations. One Spanish-speaking enrollment assister noted that it put consumers at ease to have a native speaker, rather than someone speaking Spanish as a second language, helping them to enroll. Additionally, due to the strong anti-ACA sentiment in the state, enrollment assisters reported that it was critical to be considered a trusted resource in order to overcome ideological barriers.
Reaching large numbers of people through events and local media. Enrollment events served as valuable opportunities for assisters to efficiently reach large numbers of people. For example, one of the navigator grantee organizations organized large events in rural communities to provide centralized assistance to a larger pool of consumers. These events were marketed in the local media using radio spots, newspaper ads, and movie theater ads. Additionally, some assister organizations used local media outlets to reach a large number of consumers. One organization in South Georgia held a phone bank with a local television station. The organization reported that following this event, their call volume of consumers looking for enrollment assistance picked up substantially.
What challenges and barriers remain for consumers?
Enrollment assisters identified several challenges in enrolling uninsured consumers and noted some barriers that some uninsured Georgians still face.
Many consumers had limited health insurance literacy. More than two-thirds of our survey respondents identified low health insurance literacy as a barrier to enrollment. Many of the consumers that assisters worked with had never been insured before, so they did not know how to choose a primary care physician or pay their monthly premium. One of the assisters interviewed acknowledged they needed to educate consumers on how to use their health insurance, but that it was a challenge when scheduled with a large number of enrollment appointments. Additionally, some assisters reported that consumers chose the lowest premium plan because they did not understand the concept of a high deductible. Sometimes consumers would return to the assister wanting to change plans once they had tried to use their coverage.
Many consumers fell into the coverage gap. Assisters encountered a large number of individuals and families that fell into the coverage gap, meaning that they did not qualify for Medicaid or subsidies to help them pay for Marketplace coverage and were left without an affordable pathway to coverage. Some assister organizations estimated that over half of the consumers they worked with fell into the gap. Enrollment assisters were able to provide these consumers with a list of resources where they could go to get free or low cost care, but indicated frustration at not being able to do more to help. One navigator described it as emotionally taxing to repeatedly tell consumers that came to them looking for assistance that they were too poor to qualify for health insurance.
Immigrants faced verification and language barriers. Immigrants faced many challenges enrolling in coverage. Assisters reported that, when the consumer did not speak English and the assister did not speak the consumer’s native language, using interpreter services was difficult and often ineffective. Language barriers also created difficulty because key terms and concepts associated with health insurance do not translate well. The biggest barrier for immigrants, though, was identity verification. Enrollment assisters had little or no training on how to properly verify IDs or immigration forms. Additionally, technological problems sometimes prevented them from uploading these documents to healthcare.gov. When they were unable to upload these documents electronically, consumers had to verify their immigration status through the mail, which was a long and cumbersome process. There was also a common concern from families of mixed immigration status that sharing information about their families would lead to legal repercussions. Even though none of the immigration or family information shared with the Health Insurance Marketplace is used to identify immigrants that are not here legally, this is a misconception held by many
Confusion and political opposition to Affordable Care Act hindered partnerships. Stakeholders reported that confusion and political hostility created significant barriers to outreach and enrollment. In addition, the passage of the “Health Care Freedom Act” as part of HB 943 in 2014, which included language prohibiting state and local governmental entities from operating a navigator program, among other provisions, led to confusion among local health departments and other governmental entities regarding their participation in helping consumers enroll in health insurance. An earlier version of this legislation that was not enacted, HB 707, was even more restrictive than the final language that passed and the media coverage over that bill added to the confusion. Most of these entities opted for caution, which meant that potentially powerful partnerships for enrollment were missed. This legislation also ended the University of Georgia’s navigator program (The University of Georgia operated a navigator program through its cooperative extension service during OE1).
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GHF surveyed and interviewed enrollment assisters across the state to understand not only the “what,” but also the “why” behind the second open enrollment period. The results of that research have led us to several policy recommendations to maximize health insurance enrollment and retention and to ensure that coverage translates to meaningful access to timely and appropriate medical services for Georgia health care consumers.
- Close the coverage gap in Georgia. Approximately 300,000 Georgians fall into the coverage gap, meaning they do not qualify for Medicaid under existing income eligibility guidelines in Georgia but their income is still too low to qualify for financial assistance (tax credits) to purchase health insurance on the Marketplace. Eligibility for tax credits begins at 100 percent of the Federal Poverty Level, or $11,770 for an individual or $20,090 for a family of three in 2015, while Medicaid eligibility for most adults in Georgia cuts off at income much lower. Thirty states including DC have closed their coverage gaps thus far with promising results. We encourage Georgia policymakers to take this important step as well to ensure all Georgians have a pathway to coverage.
- Set and enforce network adequacy and transparency standards. Many of the plans sold through the Health Insurance Marketplace are Health Maintenance Organization (HMO) plans that feature narrow provider networks. While these narrow networks can help keep premiums down, a trade-off many consumers may be willing to make, consumers do not currently have sufficient information to make this choice. There is no information available to consumers at the point of sale about whether a provider network is ultra narrow, narrow, or broad, and provider directories are routinely inaccurate. More transparency and oversight are needed to ensure that consumers have accurate and useful information to make these choices. It is also important that all provider networks allow for meaningful access to all covered benefits. To ensure this, we support putting in place and enforcing network adequacy standards.
- Encourage public-private partnerships and remove unnecessary restrictions on consumer education and assistance. Many of the enrollment assisters we surveyed indicated that reducing barriers to partnering with state government organizations such as public colleges, universities, and health departments would lead to stronger and more effective partnerships. Specifically, many respondents indicated that improved coordination between enrollment assisters, the Marketplace, and the Georgia Department of Community Health (DCH) to better facilitate PeachCare for Kids and Medicaid enrollment would be helpful. The “Health Care Freedom Act,” passed in 2014 as part of HB 943, prohibits state and local governmental entities from operating a health insurance navigator program and places other limitations on governmental entities. This provision has been counterproductive, creating confusion around what educational and consumer assistance activities local entities can engage in as they work to serve their community members. We recommend lifting these restrictions.
New health insurance opportunities created through the Affordable Care Act (ACA ) have led to historic reductions in the nation’s uninsured rate. Here in Georgia, more than half a million consumers signed up for health insurance during the open enrollment period that ended this past February, known as OE 2.
These strong enrollment numbers mean that more Georgia consumers can access the health care services they need and enjoy enhanced financial security for themselves and their families. The reduction in our state’s uninsured rate, although smaller than that of the nation as a whole, also has positive implications for the vitality of local health care systems and communities throughout Georgia.
Too many Georgians, however, remain uninsured, either because
- they are unaware that there are coverage options that can meet their needs and budget
- face cultural, linguistic, financial, or other barriers to coverage; or
- fall into the “coverage gap” that was created when Georgia declined to expand Medicaid as authorized under the ACA
The goals of this report are
- to explain the role of in-person assistance on enrollment outcomes and consumers’ experiences
- to explore best practices that helped achieve robust enrollment in Georgia
- to identify any common challenges or barriers to enrollment that Georgia consumers faced during OE2
- to highlight promising strategies and approaches to reach the remaining uninsured who qualify for affordable health insurance
- to put forth policy recommendations that can help facilitate a positive experience for health care consumers, both for those who are newly enrolled and for those who remain uninsured.
You can download and read the report below.
Pranaya Rana joined Georgians for a Healthy Future this week as our new Navigator! In this role, Pranaya will work with consumers to help them enroll in health insurance through the Marketplace. Pranaya is a former Lieutenant from the Nepalese Army Elite Forces. He has served as a U.N. Peacekeeper in post-earthquake Haiti and as a Refugee Resettlement Program Officer in Connecticut before he came to Kennesaw State University, Georgia to pursue his Ph.D. in International Conflict Management in 2012. He has been working as a certified Healthcare Navigator in Metro Atlanta since the first open enrollment began in 2013. He recently completed his 6 months long Navigator’s term at Georgia Watch before joining Georgians For a Healthy Future. He specializes in refugees and international communities and has served a wide variety of international communities enroll into affordable healthcare using a community specific service model developed through continued outreach, education and needs assessment. He is Fluent in Nepali and Hindi besides English, and, speaks Urdu and intermediate French. If you’d like to contact Pranaya, he can be reached by email or by phone at 404-567-5016.
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 firstname.lastname@example.org or 404-567-5016. Remember, open enrollment begins Nov. 15th—just one month away!
Today, the U.S. Department of Health and Human Services (HHS) awarded health insurance navigator grants to 105 organizations in states with federally facilitated or partnership exchanges to conduct outreach and facilitate enrollment into qualified health plans when open enrollment begins in October. Georgians for a Healthy Future is excited to announce that we are part of a consortium of 15 partners, led by Seedco, a national non-profit organization that advances economic opportunity for people, businesses, and communities in need, that received one of two grants awarded for Georgia. We look forward to playing an active role in connecting Georgia consumers to the new health care coverage opportunities available to them.
Georgians for a Healthy Future will support the consortium’s success by drawing upon our strengths as a consumer health care advocacy leader, experience building and managing coalitions, and knowledge of the Affordable Care Act. In particular, we will work to ensure that the consortium’s activities are coordinated with a wide array of organizations in Georgia that share the goal of maximizing health insurance enrollment in our state. Through our Connecting Georgians to Coverage initiative, we have already held several webinars and meetings for organizations planning to participate in outreach and enrollment in Georgia. To learn more about our work to date in this area, click here. If your organization is planning to engage in outreach and enrollment, either as a navigator, certified application counselor organization, or champion for coverage and if you would like to coordinate your efforts with ours, please email Amanda Ptashkin at email@example.com.
Here is a full list of our navigator consortium members who will work collaboratively with Seedco and with other organizations and stakeholders to connect Georgia’s uninsured to health care coverage:
- Boat People SOS
- Center for Black Women’s Wellness
- Emory-Grady Urban Health Initiative
- Georgia Equality & The Health Initiative
- Georgia Refugee Health and Mental Health
- Georgia Watch
- Georgians for a Healthy Future
- Healthy Mothers Healthy Babies Coalition of Georgia
- Jewish Family & Career Services
- Latin American Association
- Mental Health America of Georgia
- Parent to Parent
- Quality Med-Care Inc.
- Spring Creek Health Cooperative
We look forward to working with Seedco and this strong and diverse coalition over the next year!
During the 2013 Georgia Legislative Session, our state’s policymakers enacted HB 198 into law, which requires state training, licensure, background checks, and continuing education for navigators. Georgians for a Healthy Future has some concerns about this law and the potential hurdles it sets up for community-focused nonprofits already facing an uphill battle to reach, educate, and facilitate enrollment for consumers who haven’t historically had insurance. As such, we reached out to the Georgia Department of Insurance with suggestions to make the implementation of the law less burdensome for navigators, and some of our input was incorporated.
The proposed rule was presented at a hearing held by the Department of Insurance on July 30th. The regulation implementing HB 198 is available here. Georgians for a Healthy Future was also featured in two recent news articles in the Atlanta Journal-Constitution about the navigator program, available here and here. Additionally, the Center for Public Integrity just released an article focusing on various state licensure laws as they affect navigators. That article can be found here. We will continue to monitor this process with an eye towards ensuring navigators and assisters aren’t impeded from carrying out their important work.
Georgians for a Healthy Future is currently working with Enroll America to assess the interest and capacity of Georgia community-based organizations, health care-focused nonprofits, and other stakeholders in working collaboratively on education, outreach, and enrollment into the new health insurance options available to consumers in 2014 through the Affordable Care Act. As a first step, we held a webinar on April 10th and an in-person meeting on April 11th that many of you attended. For those who missed the meetings, the materials can be found here.
While a big part of those meetings focused on the navigator program, we are asking for your help today regardless of whether you plan to apply as a navigator. If your organization has a stake in covering the uninsured, we’re asking you to complete a brief survey about your current work and future plans to engage in connecting uninsured Georgians to coverage. Georgians for a Healthy Future plans to use the overall results of the survey to guide the formation of a new enrollment-focused coalition and to inform an upcoming policy brief on health insurance outreach and enrollment (all information will be reported in aggregate unless we seek and receive your permission to do otherwise).
Please take a few minutes to complete this survey. Georgians for a Healthy Future is committed to advancing the goal of covering Georgia’s uninsured by bringing stakeholders together who are interested in and able to collaborate towards this shared goal. The results of this survey will provide a baseline and starting point for this important work. Thank you!
Open enrollment into the new health insurance marketplace, or exchange, begins in just under six months (October 1, 2013) for coverage starting in January 2014. Georgia has one of the highest numbers of uninsured in the nation (1.86 million), and many of these uninsured Georgians will be able to access health care coverage for the first time through the marketplace.
According to research from Enroll America, however, more than three-quarters of the uninsured don’t know about the new health insurance marketplace. Multiple surveys have also found that when uninsured individuals learn about the new health insurance options that will become available to them through the marketplace, they say they will need help navigating the process.
That’s why the new navigator program is so important. Last week, the U.S. Department of Health and Human Services (HHS) released a funding opportunity announcement inviting organizations and individuals to apply for the navigator program. Groups may apply individually or as a consortium, although HHS is encouraging the consortium approach. Navigator responsibilities include:
- Maintain expertise in eligibility, enrollment, and program specifications;
- Conduct public education activities to raise awareness about the Exchange;
- Provide information and services in a fair, accurate, and impartial manner. Such information must acknowledge other health programs (such as Medicaid and the Children’s Health Insurance Program (CHIP));
- Facilitate selection of a Qualified Health Plan;
- Provide referrals to any applicable office of health insurance consumer assistance or health insurance ombudsman established under Section 2793 of the Public Health Service Act, or any other appropriate state agency or agencies, for any enrollee with a grievance, complaint, or question regarding their health plan, coverage, or a determination under such plan or coverage; and
- Provide information in a manner that is culturally and linguistically appropriate to the needs of the population being served by the Exchange, including individuals with limited English proficiency, and ensure accessibility and usability of Navigator tools, such as fact sheets, and functions for individuals with disabilities in accordance with the Americans with Disabilities Act and Section 504 of the Rehabilitation Act used in Holistic Drug and Alcohol Treatment centers and other similar types of organizations.
For entities interested in applying for the navigator funds, letters of intent (optional but recommended) are due on May 1, 2013 and applications are due to HHS on June 7, 2013. To learn more about the navigator funding opportunity, click here.
Nearly 100 of you joined us last week for a meeting to begin discussing how consumer and community-focused nonprofit organizations can work collaboratively to maximize enrollment in Georgia. The meeting also was an opportunity for organizations considering applying to HHS for the navigator grants to network with each other and see if there were opportunities to submit joint applications. To those of you who were unable to join us, here are the resources and materials that were shared:
- HHS navigator funding opportunity announcement
- Georgians for a Healthy Future’s navigator fact sheet
- Enroll America’s enrollment assisters fact sheet
- Enroll America’s navigator and in-person assistance programs
- Enroll America’s bridging the enrollment gap: the importance of providing in-person assistance
- Enroll America’s power point presentation
- Seedco’s power point presentation
- Webinar power point presentation
Join us for a webinar and in-person meeting about ACA Navigators April 10 and 11
If you or your organization are interested in applying for the upcoming funding opportunity provided through the Department of Health and Human Services (HHS) for navigator grants or you would like to connect with other organizations who will be applying, please join Georgians for a Healthy Future, Seedco, Families USA and Enroll America for an important webinar on April 10th, 2013 at 11am and an in-person meeting on April 11th, 2013 from 2:30 to 4:30pm at the Philip Rush Center (1530 DeKalb Ave).
In the next few days, HHS is planning to announce funding that will be available to organizations for outreach and assistance to help individuals and small employers enroll in health coverage. These grants are created as part of the navigator program that was established by the Affordable Care Act. To learn more about navigators, click here.
To join us for the webinar, please click here to RSVP. To join us for the in-person meeting to further discuss this funding opportunity and opportunities for collaboration on outreach and enrollment, click here.