Funding Opportunity Announced for Illinois In-Person Counselors

Beginning October 1, 2013, the Illinois Health Insurance Marketplace will open for enrollment. Pursuant to the Affordable Care Act, the Marketplace will be a website where those seeking insurance coverage can shop for health care and determine if they are eligible for financial assistance with premiums and health costs. In Illinois, we are estimating that more than half of our Health Insurance Marketplace customers will want help enrolling in the program.

In order to meet their needs, Governor Pat Quinn and the Illinois Health Insurance Marketplace established the In-Person Counselor program (IPC). IPCs will educate people about the new system, help them understand their health plan choices, and facilitate their selection of the plan that is right for them. IPCs will be instrumental in the Marketplace’s plan to create a statewide “Culture of Coverage” by engaging, educating, and enrolling the uninsured in Illinois in qualified health plans.

Today, the Illinois Health Insurance Marketplace is very excited to announce the release of the grant application for the In-Person Counselor program.

The Illinois Health Insurance Marketplace, in coordination with the Illinois Department of Public Health, will be accepting applications through the end of May 2013 from community groups and other qualified organizations who want to participate in the IPC program. The state has designated approximately $28 million in federal funds for grants to participating groups. Organizations that are selected through the online application process will participate in a training and certification process this summer.

For more information about the application process for the Illinois IPC Grant Program, go to: http://www2.illinois.gov/gov/healthcarereform/Pages/IPC.aspx.

Additionally, the Illinois Health Insurance Marketplace will also conduct an informational webinar on Thursday, May 9 at 10:00 AM. Interested groups can register for the webinar by going to https://www305.livemeeting.com/lrs/8002054163/Registration.aspx?PageName=hfhrvf978qb8w95p.

Thank you,

Brian Gorman

Director of Outreach and Consumer Education
Illinois Health Insurance Marketplace

A Simpler Way to Apply for Health Care

By Kathleen Sebelius, Secretary of Health and Human Services
Posted April 30, 2013

Today, we take one more step toward meeting the promise of helping millions of Americans access quality, affordable health coverage.

We have finalized the application you can complete later this year to learn what health insurance programs you are eligible for and the discounts to help pay for it. Starting in October, it will be the one application you can use to apply for the new Health Insurance Marketplace, Medicaid, the Children’s Health Insurance Program, and tax credits that will help pay for premiums.

I’m also pleased to say the application has been simplified and significantly shortened. The application for individuals is three pages, and the application for families is reduced by two-thirds, to seven pages. This is much shorter than industry standards for health insurance applications today.

Whether you choose to use this application to apply for coverage online, by phone, or on paper, the Health Insurance Marketplace will give you better options than they have today – with one destination to apply and many resources to get help. In-person counselors and a toll free phone line will be available to help you through every step of the process.

The online application that will go live on Healthcare.gov when the Health Insurance Marketplace opens for enrollment on October 1, can be found here: http://cciio.cms.gov/resources/other/index.html#hie

You can sign up to learn more and get ready to enroll at signup.healthcare.gov.

(This post was originally on the healthcare.gov blog here).

Update on SB 1194 (The Insurance Navigator Act)

Starting October 2013, an estimated 1.6 million Illinois residents will be eligible for new and affordable forms of public and private health insurance coverage under the Affordable Care Act. But the overwhelming majority of the newly eligible have no idea how to access these options. Many Illinoisans will need more information and guidance through the enrollment process.

The Affordable Care Act requires each state’s Health Insurance Marketplace to establish a Navigator Program that will guide these individuals through their new coverage and enrollment options. These Navigators will serve an important role in ensuring that individuals benefit from the ACA.

On January 30th, the potential efficacy of the Navigator program was threatened by the introduction of Illinois Senate Bill 1194, which would create overly restrictive criteria for organizations applying for and performing navigator functions.

Here are the issues with SB1194 (as it was introduced):

• SB1194 placed unnecessary restrictions on Illinois Navigators and In-Person Assistors, making it more difficult for low-income and hard-to-reach populations to connect to the application assistance that they need.  
• Illinois is currently preparing a Navigator training and oversight system that makes SB 1194 unnecessary. 
• Federal law already mandates some of what is outlined in SB1194, such as prohibiting Navigators from recommending specific insurance products. Once again, SB1194 is unnecessary.  
• Language in SB1194 prohibited Navigators from facilitating enrollment in a Federally Qualified Health Plan, (QHP), one of the five Navigator duties already specified by the ACA.

Consumer advocates and community based-providers recognized these issues, and successfully lobbied state Senators to make changes in the bill.

Here’s what changed:

• SB1194 now includes the Navigator duties as spelled out in the ACA.
• SB1194 now includes a certification, instead of a licensure, requirement.
• SB1194 excludes all prior language that restricted Navigator duties, (such as the ability to facilitate enrollment in a QHP).
• SB1194 is now in alignment with Federal regulations regarding the training and responsibilities of Navigators.
• SB1194 now allows for the training of Certified Application Counselors, (another type of Navigator not directly compensated by the Exchange), to be defined at a later date. This means that CAC training will align with federal guidelines.

What’s happening now?

These amendments were filed on April 22nd, passed in the Senate on the 24th, and were referred to the House Rules Committee earlier today. You can follow SB 1194’s status here.Thanks to all of the advocates for raising your voices against restricting the navigators in this new health care system.

Nadeen Israel
Policy Associate, Heartland Alliance for Human Needs & Human Rights

Please contact Nadeen at nisrael@heartlandalliance.org for more information on SB1194.

The “Rate Shock” Myth

As Affordable Care Act opponents continue grasping at straws to find fault with the law, an assertion perpetuated by the insurance industry that the ACA’s coverage expansions will significantly increase premiums has gained prominence. Lately, many insurance industry-funded studies and the resulting news coverage of them have focused on the potential for “rate shock” for the young and healthy, fear mongering young adults and others into thinking their rates will skyrocket come 2014. None of these reports address all of the protections written into the bill to prevent steep rate changes and many fail to accurately represent the true scope of benefits and costs. Community Catalyst has prepared this fact sheet to help cut through some of the confusing arguments swirling around.

Very few people will be affected by significant rate changes. To give a sense of how small this number is, more than half of employed 19-44 year-olds were covered through their employers. Of those who are not offered insurance through an employer, 92 percent of young adults expected to enroll in individual plans with subsidies through the Exchanges would not be subject to premium increases. This is not to say that nobody will experience rate changes, but it is important to understand the relative impact of increases and the small number of people affected.

Rate changes will primarily impact young men between the ages of 19-27, who have incomes higher than 400 percent of the federal poverty level (more than $45 thousand per year) and are not covered through their employers. And even these individuals will only experience moderate changes – on average an increase of 10-13 percent compared to current non-group rates, according to the Congressional Budget Office.

Most importantly, the ACA means everyone will gain increased value per health care dollar through better benefit packages and limits on how much patients can pay out-of-pocket. New plans will be required to meet certain standards of benefits, including covering maternity, mental health, prescription drug coverage, and charging no co-pay or deductible for preventive services including cancer screenings and contraception. These new standard benefits ensure that consumers will get greater value and better protections than many plans currently provide. Young adults will also have the option of enrolling in a catastrophic coverage plan that covers the same benefits but offers lower premiums with a higher deductible.

The law also makes the system fairer across gender and age groups. Currently, insurers commonly charge women more than men, simply because they have the potential to incur more costs through maternity care. This unfair practice costs women in the private market approximately $1 billion per year, but is outlawed under the ACA starting in 2014. Similarly, insurers are allowed to charge older adults significantly higher rates. The ACA places limits on this practice so older adults can only be charged a maximum of three times as much as younger adults. This change reflects a more accurate approximation of the health cost differences between young and old, correcting years of overcharging adults for their health care services. Finally, the ACA ends discrimination against those who have preexisting conditions. This is not irrelevant for young adults, since 16 percent of 16-24 year olds have preexisting conditions and either are unable to gain coverage or are pay higher rates because of their medical history.

When it all shakes out, the benefits of the ACA for young adults far outweigh any costs. The impact of premium changes will be limited, will help make the health insurance system fairer, and will ensure consumers get more bang for their buck.

Sarah Gordon, Private Insurance Team Intern
Community Catalyst

(Blog originally appeared here on the Health Policy Hub)

The “Culture of Coverage:” How Illinois is making the Health Insurance Marketplace Work

On March 29th, Illinois submitted an outreach and enrollment plan to the federal government, a requirement for all states participating in a state-federal partnership health insurance exchange. In the proposal, the marketplace team explains that they plan to treat outreach and enrollment like a political campaign, working not to elect a candidate but instead to introduce a new “health culture” to Illinoisans who have traditionally been excluded from coverage. The campaign will launch full-force in July in order to address skepticism and the general lack of awareness around the Affordable Care Act before enrollment begins on October 1st of this year.

Campaign values:
Illinois faces a variety of challenges, including limited English proficiency and low literacy rates, which make the task of reaching and enrolling certain populations of residents difficult. 78% of uninsured adults and 83% of the Medicaid population are unaware of insurance options under the ACA. To insure that Illinois is successful in promoting awareness of the Affordable Care Act, the marketplace team’s work will be guided by the following principles:

1. Promotion of a State-wide Culture of Coverage; 
2. Empowerment of Community-Based Organizations and Stakeholders; 
3. Metric-Focused Encouragement of Enrollment; 
4. Promote Health Care as a Value; and 
5. Build a Strong and Trusted Reputation Among All Residents. 

Campaign strategy:
Based on the assumption that many Illinoisans aren’t aware of their options, the marketplace team will hire a professional marketing firm by the end of May. This firm will work to create a cohesive brand that speaks to target populations while establishing the Illinois marketplace as a trusted entity and something that residents will want to participate in. This media campaign will consist of television, print, outdoor, direct mail, online, and social media advertising.

The field program:
While the exchange branding is no doubt important, the marketplace team recognizes that empowering community partners to assist in the outreach and enrollment process may be the most effective way to achieve a “culture of coverage,” as these community partners are already known and trusted entities. This collaboration, titled the “field program,” will focus on the “4 E’s:” Engage, Empower, Educate, Enroll.

Staffing structure:  
Illinois will be divided into 8 “Outreach Regions,” which will be constructed geographically and by information around where the uninsured in Illinois reside. Each region will be headed by an Outreach Coordinator, who will report to the Director of Outreach & Consumer Education.

In order to assist with enrollment, three categories of assisters will be established. Similar training must be undergone in order to qualify for each category. The assister categories are as follows: 

1. Navigators: part of a federally-run assistance program 
2. In-Person Counselors: a state program that will coordinate with Regional Outreach Coordinators. Selected entities are expected to spend one year as assisters. 
3. Certified Application Counselors: Additional national funding for individuals who aren’t funded through grant money.

It’s coming…
The marketplace team is already working hard to make sure the health insurance marketplace works in Illinois. In the meantime, click here to check out the full Illinois Health Insurance Marketplace Outreach & Education Plan!

Kathryn Bailey
Health & Disability Advocates

Will Illinois Have Enough Family Physicians Beyond 2014?

Do we have enough physicians to care for newly insured patients seeking care starting Jan. 1? Some will be covered by Medicaid; some gain coverage through the insurance marketplace; and others turning 65 join the ranks of Medicare. The Illinois Academy of Family Physicians believes that we are ready for 2014 – but are not prepared for future demand for primary care.

Illinois currently has the capacity to care for more than 5.3 million Medicaid patients, with more than 5,000 primary-care providers participating in team-based medical homes. When patients have a regular primary-care physician, they get the care they need to avoid costly emergency room visits and hospitalizations. Connecting new Medicaid patients with a family physician ensures they get the right care at the right time in the community setting, at a much lower cost. Otherwise uncontrolled chronic illnesses can develop into costly – and preventable – hospitalizations, which drives up medical costs for everyone.

Illinois has 11 medical school campuses. This year, only 9 percent of 1,089 doctors graduating from those medical colleges chose family medicine, according to IAFP data. And only one-third of that 9 percent — 35 people — will do their residency training in Illinois; the rest will leave for other states. Family physicians are the only physicians trained to care for all ages, both male and female.

Illinois should worry about the future of our state's primary-care physician workforce. Simply stated, too many physicians trained here choose to work in other states, and Illinois is not training enough primary-care physicians.

A NATIONAL PROBLEM, TOO

According to the American Association of Medical Colleges workforce data book, Illinois ranks 20th in the nation with 95 primary care physicians per 100,000 residents. As a nation, we are facing a staggering shortage of primary care physicians. So being in the middle of the pack should not be interpreted as a positive sign.

A 2010 study led by family physician Russell Robertson (now dean of Chicago Medical School) examined new physicians' plans for practice and the reasons for their choices. Almost one-half of graduating Illinois residents and fellows leave the state to practice elsewhere. While the primary reason for do so is for family, the medical liability climate is a major consideration for those who leave Illinois to practice.

How can we turn the tide? Medical schools need admission policies favoring students willing to practice in Illinois. We also must address medical school debt that keeps many from entering primary care. Those physicians should get loan repayment or loan forgiveness incentives to practice in areas in need of primary-care physicians. As well, the income gap between primary-care and specialty physicians must be narrowed. Medicare and Medicaid must take the lead and pay primary-care physicians in accordance with the quality care and coordination services they provide, and private insurers must support primary care.

Making primary-care practice a priority ensures that every Illinoisan entering the health care system has a medical home to care for them. A future without enough family physicians will leave patients without a medical home and on the doorsteps of emergency rooms instead.

Dr. Carrie E. Nelson is president of the Illinois Academy of Family Physicians, based in Lisle.

This article was first published in Crain's Chicago Business

Great News for the People of Illinois...Now What?

Yesterday, Governor Quinn announced that Illinois was awarded a $115 Million grant for its Health Insurance Marketplace (the online portal to enroll over a million adults and children into quality health plans). A large portion of this federal funding will pay for outreach activities and consumer assistance during the push to enroll the uninsured beginning on October 1 of this year.

This is great news for the people of Illinois.

With October 1 less than six months away, we need these federal funds to help get the word out about the availability of new insurance coverage options. According to Enroll America's research findings, the  majority  of  uninsured Americans  don’t  know the  health  reform  law  will  help  them:

• 78% of  the  uninsured  don’t  know  about  the new  health  insurance  exchanges  
• 83% of  people  who  could  be  eligible  for  the new  Medicaid  expansion  don’t  know about  it.  

Tremendous amount of work needs to get done to tell people about the new options and enroll them into a plan. 

Here's a timeline of what needs to happen to be ready by October 1, 2013. Since Illinois is running its exchange/marketplace in partnership with the federal government, we need to be mindful of activities by both the feds and the state:

Already Happened:

• Illinois Marketplace Team Selects Training Vendor (UIC/Public Health)
• Marketplace Team Releases Outreach & Education Plan & Conducts Outreach to Encourage Navigator & In Person Assister (IPA) Applications. (Read this fact sheet to learn about the different Consumer Assistance Entities needed).
• Marketplace Team Receives Establishment Grant Funding
• Illinois Marketplace Team Releases RFP for Media and Marketing Outreach Strategy.
• CMS Releases Proposed Standards for Navigators and In Person Assisters (see here for a good summary)
• Federal Government Releases Navigator RFP (Just released today, April 9, 2013; due June 7,
  2013; Expected Award Date - August 15, 2013). 
• Advocates create the Illinois Consumer Assistance Matchmaking Spreadsheet to find partners in either the federal Navigator grant or the (yet to be released) Illinois Assister RFP.

Spring 2013:

• Marketplace Team Issues RFP/Grant Application for IPA entities
• Marketplace Team Approves IPA Training Materials
• Marketplace Team selects firm for Media and Marketing Outreach Strategy (UPDATE: On 7/12/13 Fleishman Hillard is selected)

Summer 2013:

• Federal Government Selects Navigator Entities (Due date for application: June 7, 2013)
• Marketplace Team Selects IPA entities (see list here) 
• Federal Government Takes Applications for Certified Application Counselors (sign up here)
• Navigators, IPAs, Certified Application Counselors (CACs) Receive Training and Certification.
• Media placement begins

October 2013 and beyond:

• Navigators, IPAs & CACs Assist Consumers during Open Enrollment
• Navigators, IPAs & CACs Provide Post-Enrollment Assistance & Assistance during Special Enrollment Periods
• Program Oversight Conducted By Marketplace Team and Federal Gov’t.

The timeline is tight and we need all types of entities (community based organizations, hospitals, health departments etc.) to help with enrollment.

If you have any questions about  what this means for you or your organization, please don't hesitate to contact us at info@illinoishealthmatters.org.

Stephani Becker
IHM Project Director