Health Action 2020 – What You Missed from the Outreach & Enrollment Track
February 14, 2020 | By Transform Health
Health Action 2020 has come and gone but we wanted to be sure to bring our outreach and enrollment experts who could not attend this year some of the highlights through this blog. We are grateful we were able to celebrate and highlight the incredible work you are doing through the Transform Health sponsored enrollment track. Over the course of #HA2020, our team heard from many different voices in the outreach and enrollment space, from Navigators, Certified Application Counselors in Community Health Centers, Primary Care Associations to non-profit brokers, as they continue to work in a political environment where their roles in the health care delivery system, access and coverage, are constantly at risk. The enrollment track consisted of two panels, a happy hour with our friends at NACHC, and a world café style discussion to talk about mechanisms for funding outreach and enrollment work.
Outreach and Enrollment Will Always be Mission Critical
Our first session, “Outreach and Enrollment Will Always be Mission Critical”, was moderated by Transform Health’s CEO, Lisa Chan-Sawin, and featured Lisa Olson, Legislative Director for WisconsinDepartment of Health Services, Shelli Quenga, Director of Programs for the Palmetto Project, and Jodi Ray, Program Director of Florida Covering Kids & Families. This session focused on the lessons learned while working in turbulent outreach and enrollment environments. Like many across the country, each panelist came from a different background in the outreach and enrollment space and have their own unique landscape and set of challenges. Shelli Quenga represented a non-profit broker model in South Carolina, Lisa Olson, a state government agency in Wisconsin, and Jodi Ray, a Navigator agency in Florida.
Given the Federal cuts to Navigator programs nationwide, Wisconsin found a way to fund outreach and enrollment through their state budget this year knowing that consumers need help with enrollment, they launched a statewide campaign. This effort allowed for state-based funding for Navigators during Open Enrollment 7 (OE7), that included a $500,000 grant to sustain critical outreach and enrollment activities. This grant allowed Wisconsin’s Department of Health to partner with United Way Wisconsin and Covering Wisconsin, both Navigators, to train 2-1-1 health centers, develop a robust coordination workflow and conduct a media campaign geared towards enrollment.
Shelli Quenga, Director of Programs for the non-profit The Palmetto Project highlighted how her consumer-focused, non-profit broker model in its second year implemented a “one-stop-shop” philosophy. Almost all of the non-profit brokers at the Palmetto Project come from a social services background, which gives them the ability to enroll some of the hardest to reach, high-needs populations. They also serve dual-eligibles (Medicare and Medicaid) and are helping consumers enroll in Medicare Savings Programs, which eliminate late enrollment penalties for Part B (Medicare’s outpatient coverage), pay the Part B monthly premium and automatically make beneficiaries eligible for Extra Help for Medicare Part D. Shelli also highlighted how the use of real consumers in their local enrollment commercial helped generate greater interest in enrollment this year, particularly with no advertising coming from the federal government. Their local approach was aimed at communities with a history of distrusting the government and health care system.
Finally, Jodi Ray, who heads Florida’s statewide Navigator program out of the University of South Florida, spoke about how to navigate the challenges retaining staff in a changing landscape of outreach and enrollment, both in Florida and nationally. Her presentation focused on Florida’s Covering Kids & Families response to these changes, such as employing state-wide branding to reduce consumer confusion, consolidating their workforce, staffing cuts, and pairing down remaining infrastructure to reduce costs, as well as (though not ideal) increasing virtual appointments. She also discussed how broadening partner networks to include elected officials on both sides of the aisle with a large constituent reach helped to advance their enrollment goals focusing on people over politics, while also continuing to work with schools and faith-based organizations.
Many participants were interested in the combination of the panelists’ perspectives on how to provide outreach to people who need ongoing help, and how to enroll hard-to-reach populations with limited staff, resources, and cuts to funding. While difficult to do, the panelists encouraged participants to ground their philosophy in “meeting people where they are,” “go off script” and “be willing to go where others won’t.” To learn more, check out this sessions slides.
Federal Policy Update with Young Invincibles
We kicked off the final day of the conference with our outreach and enrollment networking breakfast, co-sponsored with Young Invincibles (YI). Our D.C.-based Policy Analyst Sara Gleysteen presented alongside Young Invicibles’ Health Policy and Advocacy Director, Erin Hemlin on a federal policy and OE7 update. This session was dedicated to a review of the major changes in the health policy landscape during 2019, and a recap of the Get Covered Connector resource numbers provided by YI.
The federal update included six changes that have had a serious impact on consumers in 2019 – including drug pricing, the Trump Administration’s efforts to liberalize regulations on short-term health plans, and the fate of the Affordable Care Act (ACA), Public Charge, and Medicaid work requirements. Erin Hemlin delved deeper into the data of OE7, answering important questions such as, what really were the total number of new enrollments? What were the biggest changes affecting consumers? What are the key takeaways from this OE period?
In OE7, the total number of new enrollments was 8.3 million people, which is largely due to the strongenrollment assistance community. Compared to OE6, which saw about 8.34 million enrollments, the overall steadiness in OE7 demonstrates the continued demand for high quality, affordable health coverage and the resiliency of the ACA. Other factors that effected enrollment like the defunding/deregulation efforts by the Trump Administration, as well as some of the policy changes mentioned in the federal update like Texas v. US and the chilling effect produced by Public Charge, put pressure on enrollment which was expected to decrease. Despite these factors, increased competition from more insurers entering the market and increased affordability (9 in 10 shoppers qualified for financial help; of those 2 in 3 could find a plan for $10/month or less) balanced enrollment for the OE7. To learn more, check out the slides.
Outreach and Enrollment Funding and Programming Landscape
Our last session “Outreach and Enrollment Funding Programming and Landscape”, facilitated by Transform Health’s COO Heather Bates, was intended to break from the typical workshop style and create space to discuss different funding mechanisms for outreach and enrollment programming. The room was split up into small, facilitated groups and each group focused on a different topic, such as enabling services and the ways this work supports outreach and enrollment in health centers, non-profit broker models and how to go about pursuing one in your state, Medicaid Administrative Claiming and how to do it, and how to leverage Medicaid waivers for outreach and enrollment work—with the caveat that waivers are a “superpower, they can be used for good or evil.”
Sonia Lara, the Outreach and Enrollment Director/Special Populations Coordinator for the Texas Association of Community Health Centers (TACHC) and Bethany Hamilton, Deputy Director of State Affairs for National Association of Community Health Centers, co-led discussions with health centers. Attendees who joined this group discussed, that while enabling services are absolutely crucial to outreach and enrollment, they are often the first to get cut when funding is tight. With that in mind, the group found that being able to apply a meaningful and quantifiable impact to enabling services through the use of strategies like story-banking helps define their worth.
Matt Slonaker, Executive Director of the Utah Health Policy Project and Shelli Quenga, Director of Programs for the Palmetto Project, led group discussions on different approaches to building non-profit broker models. They walked their groups through the benefits of this model, especially for those operating in “red states” as non-profit brokers can be viewed more favorably in conservative political landscapes because the model takes on a “social enterprise” tack. The discussion also highlighted how being a Navigator can be restricting depending on the circumstance. In Utah, for example, the legal landscape has many barriers for Navigators such as binding Navigators to conflict of interest laws or barring them from commissions. In South Carolina they talked about how each of their staff receives a salary and the commissions go back into the non-profit budget overall. The non-profit broker model can provide a sustainable funding stream, but also has less workforce limitations, and different state regulations and laws impact whether one can build this model.
Finally, our team members Lisa Chan-Sawin and Sara Gleysteen led discussions on Medicaid waivers and Medicaid Administrative Claiming respectively. The Waiver group talked about how Medicaid waivers can be harnessed for good and bad, and specifically discussed how the 1115 Waivers could be utilized to fund outreach and enrollment into Medicaid as part of a larger proposal to increase access benefits and eligibility for low-income individuals—as is the case in California where Navigators are serving as the central management entity for health and housing pilots. Medicaid Administrative Claiming (MAC) drew a lot of questions as the topic itself is complex and varies in its federal match from state to state. Generally, MAC is a Federal Financial Participation that is matched to activities that contribute to the efficient and effective administration of the Medicaid program. That means that MAC can be used to fund outreach and enrollment into Medicaid. Models like the enrollment kiosks in New Mexico, Facilitated Enrollment in New York, and the Illinois All Kids Application Assistance grant were all examples of how to draw down Medicaid dollars through the MAC mechanism to fund this work.-
In sum, we continue to be inspired by the fearless and tireless work that continues to be essential in each community across the US. We also understand that unlike prior years, there was a concerted effort had during the national funder conversations this year about renewing the funding for outreach and enrollment work again, and we strongly encourage you to contact your program officers to discuss the need for this work. Outreach and enrollment efforts across the country continue to be foundational for all of the staff of Transform Health and each of us would like to take this blog opportunity to sincerely thank the consumer assistance community. We look forward to connecting with many of you and hope to see you in 2021!