Interview with Matt Slonaker, J.D., Executive Director of Utah Health Policy Project
In 2017, shortly after the presidential election and with the reduction in funding for the Federal Navigator program, we started to look at alternative models in order to continue serving Utahns. It quickly became clear the Federal Navigator program could not sustain a robust health insurance outreach and enrollment program in the state of Utah; the Navigator grant placed a number of restrictions on grantees, limiting the type of organizational revenue that could support outreach and enrollment activities. We certainly didn’t want to close up shop, so we started meeting with community partners to find sustainable avenues to continue our work. We were pleasantly surprised by the amount of local support there was to keep our outreach and enrollment program alive.
What key decisions were made for Utah Health Policy Project (UHPP) to shift to a nonprofit broker model?
In Utah to assist people with health insurance, the parameters set forth by the state are very narrow. With Federal Navigator grant funding ruled out, our only option at the time was then to become a Producer (known as “broker” in other states). For many, the word “broker” can evoke some negative feelings because the thinking could be, they are biased or steer people into certain types of plans. But much of that sentiment comes from the for-profit, commission-based environment where volume is championed over customer service. Stories of brokers who set up cardboard offices on November 1st in strip malls across America comes to mind. We’ve even heard of brokers who change their phone number the day after open enrollment so as to not be bothered by the clients they signed up.
But not all insurance brokers are the same, and in Utah, community-based organizations have a history of teaming up with brokers. In fact we worked with brokers to set up set up Take Care Utah—UHPP’s outreach and enrollment program. Health care insurance is complex and confusing and too many people make the wrong plan choice. Nonprofit insurance broker models allow for a mission-driven approach as opposed to a sales or commission-driven approach. We find that we fill a niche in serving mixed status families and are able to take on time consuming, complex cases—without a profit motive front and center. We also help families with Medicaid and the Children’s Health Insurance Program (CHIP), unlike the traditional broker.
What changes or challenges have you faced since the transition to nonprofit broker?
Although shifting from a Navigator to a nonprofit broker model comes with its challenges, what has not changed are our core values and focus on serving vulnerable populations in an impartial manner. We are still very much a nonprofit, and every dime we receive through commissions or other earned revenue goes back to our overall budget in order to meet our mission. As far as changes, now, each Health Access Assister must become a licensed and appointed agent. UHPP must also have a license. The training is more rigorous than Navigator licensing and some Health Access Assisters have struggled with meeting the requirements. We also work much more closely with insurance plans. Which, overall, has been a good thing. We understand the products, benefits and networks in far more depth than we ever did as Navigators. As a result of this shift, we are better at serving our clients.
A critical piece of continuing to serve our clients is to ensure we have a sustainable funding strategy, which must include diversified funding streams. We continue to receive funding for outreach and enrollment from various state federal funding sources—around 60%. This funding is vital and allows us to focus on CHIP and Medicaid, in addition to the ACA Marketplace. We also have entered a number of service contracts with plans and providers to conduct member “coverage to care” activities and enrollment services. If we were to lose any one of these funding streams our program would not collapse, which we know is an unfortunate reality for some.
During our first year, we were just ramping up, and a number of our brokers weren’t fully licensed until just before open enrollment began. We were happy with our numbers, but though we’d enroll more clients. Now our outreach and enrollment numbers are higher than they’ve ever been. Not just compared to our first year, but even higher than when we were a Federal Navigator. State policy changes such as Medicaid expansion, although not full expansion, allowed thousands of Utahns to gain access to Medicaid coverage.
With these policy changes coinciding with our transition and development of the model, we’ve found that our ability to fundraise and develop programming has expanded. As nonprofit insurance brokers, we have the flexibility to change our model, adapt and try new things including gaining new revenue sources to finding new ways to partner.
What are some of the key lessons learned during implementation?
Our lessons learned have shown us that if you’re going to start, start early, because transitioning from Federal Navigator to nonprofit broker can be a long and challenging process. We’ve found that the nonprofit, social enterprise model is surprisingly popular in more conservative states such as Utah. The level of support and encouragement we received from our state officials and community leaders were not shared when we were a Federal Navigator, but public opinion about our work has since changed and bolstered Take Care Utah during our transition to becoming a nonprofit insurance broker.
Now, during this open enrollment period, we are utilizing these lessons learned and expanded opportunities from the model to inform our operations. We aim to have a texting platform fully implemented in the near future and make better use of referrals and social media as a way to expand. Over the years, we have also found that collocating with clinics works best when they set up client appointments for us.
This model and more will be discussed at the annual Families USA Health Action 2020 Conference in Washington, DC, in January 2020. If you are an Navigator, CAC or CHW, or work to support this workforce such as Primary Care Associations, community health centers, state governments, or advocacy organization, we hope to see you in DC to learn more about models like Take Care Utah, and the incredible work that is being done across the country for outreach and enrollment. Message us for a special discount code for enrollment assisters and join us for our enrollment track and dedicated events to honor your work.
Contact Us
If you would like to learn more about Utah Health Policy Project and their nonprofit broker model please contact Matt Slonaker matt@healthpolicyproject.org or more with Transform Health please contact Heather Bates at heather@transformhc.com.
Please see our previous blog post about a nonprofit insurance broker model in South Carolina here.