Say Ahhh!

HHS announced today that up to $1 million per state will be available in grants to begin establishing health insurance exchanges. This first round of grants is designed to help cash-strapped states conduct the research and planning necessary to build the new marketplaces. Grant applications are available at: http://www.healthcare.gov/center/grants and are due by September 1, 2010 (there is a pre-application call scheduled for August 5th). Only states are eligible to apply for the grants and no matching funds are required. 

In describing their planning activities in the grant application, states must include information on how they will involve stakeholders in the decision making process, as well as how they plan to build on and integrate the exchange with existing public programs such as Medicaid and CHIP. And in a nod to transparency, states must post information about the planning grants on their websites.  

The administration also released a request for comments on the standards and rules that Exchanges will be required to meet. The administration is encouraging states, consumer advocates, employers, insurers, and other interested stakeholders to provide input. To add your two-cents, go to: http://www.healthcare.gov/center/regulations. Comments are due by October 4, 2010.

By Christine Barber, Community Catalyst

We've all heard the recently-passed Affordable Care Act (ACA) provides a lot of new opportunities for improving health care coverage and access - but we also hear most Americans don't understand what the law actually means for them. At Community Catalyst, we think a major opportunity created by national health reform is improving consumers' access to clear information about their health care options from trusted sources. Consumer assistance programs (CAPs) are a critical way to make this happen.

The ACA included $30 million in grants for 2010 to fund state CAPs and ombudsman offices (Section 1002) to help real people understand their health care options. And the Department of Health and Human Services Office of Consumer Information and Insurance Oversight (OCIIO) just released the grant guidelines for the program late last week. Overall, we at Community Catalyst applaud the guidelines.

A few highlights:

• The grant criteria take steps to ensure that the selected programs are independent. In particular, we are happy to see that the guidelines clearly welcome states to contract with non-profit organizations to provide consumer assistance.
• CAPs must assist people with all types of coverage and provide assistance that is culturally appropriate. In addition, programs must collect data about any problems and questions, which we hope will provide real-time, on-the-ground information about what's working and what's not. Regular feedback to state and local policymakers can help improve health reform implementation.
•  Each state is eligible for one grant award. Therefore, it is important that states know about this grant program, so consumers can get help, no matter their zip code.

Examples like Health Care for All Massachusetts's Helpline, New York's Community Health Advocates, and Health Assist Tennessee have shown us that strong consumer assistance programs can mean the difference between a failed attempt and successful reforms. The Helpline in Massachusetts saw their call volume increase by 400 percent after Massachusetts's health reform law passed. People still call with questions, from enrollment assistance to help with paperwork to navigating the health system.

We hope that states will partner with community-based non-profits wherever possible to help provide consumer assistance. We have seen these models work, and know that they are trusted sources of health care information for communities and for families looking for help in understanding a system that's about to get bigger and more complex.

The CAPs grants are an important step in making sure the public understands and can navigate the health system as it changes. Grant applications are due September 10, and year-long grants will be awarded to states this October.

By Sabrina Corlette, Georgetown Health Policy Institute

In the last couple of weeks there have been reports that some insurance companies have decided they will no longer market "kids-only" policies, in response to the new requirement under the Patient Protection and Affordable Care Act (ACA) that they issue coverage to all children, even those with pre-existing health conditions.  What are these "kids-only" policies, and how many families will be affected if plans drop out of the market?  

Only a small percentage of families buy kids-only commercial coverage - by some estimates these plans constitute 8% of all policies offered on the individual market (in fact, AHIP  found that its surveyed members only cover about 150,000 children through kids-only policies).  In some cases, the parents who buy these policies can't obtain coverage themselves, because it's simply unaffordable or they have health conditions that cause insurance companies to deny their applications.  In other cases, a parent has access to insurance through their job, but it's much cheaper to buy a kids-only plan than to purchase family coverage. 

Currently, companies that sell kids-only policies engage in underwriting, which allows them to deny policies to children who have health conditions.  And if they do issue policies to these children, they often refuse to pay for the very treatment that would help them get better.

The ACA includes an important new reform for families with children that have pre-existing health conditions - as of September 23, 2010, plans are no longer allowed to deny these kids coverage, or to exclude from policies the benefits they need.  This provision is estimated to help 162,000 kids get coverage they otherwise wouldn't have.

This is a reform that should be embraced by everyone - how can anyone justify denying a child access to health care?  And early on, most health insurance companies said they would willingly comply with the new rules.

But lately, that commitment has started to crumble as the companies look at their bottom line and realize that covering kids who need health care will drive up their costs.  In a move that demonstrates how dysfunctional our health system has become - and why the broader insurance reforms, slated to go into effect in 2014, are so vital - many are now saying they want to get out of the kids' market.

What does this mean for families?

First of all, families with children currently enrolled in a kids-only policy don't need to panic.  Under another federal law - the Health Insurance Portability and Accountability Act (HIPAA) - these policies are "guaranteed renewable," which means that they can keep their children enrolled in the policy if they wish.  Most plans won't completely exit the market - they are simply no longer selling the policy to new customers.  Families should be aware, though, that they could face higher premiums over time.

For families whose kids don't currently have coverage, they may find that fewer plans are offering kids-only policies.  But that doesn't mean they won't be able to access coverage. Many families will want to explore whether their child is eligible for Medicaid or CHIP, both government-sponsored programs for low- and moderate-income families available in every state. Most uninsured children in the country - two out of three - are eligible for these programs, which offer affordable coverage without imposing any pre-existing condition exclusions.

If parents are looking for insurance on the individual market, they should check out the new HHS website, www.healthcare.gov.  The site has easy-to-use comparative information on health plans' family coverage options in every zip code. And under the ACA, even if their child has a pre-existing health condition, plans will no longer be able to deny them coverage or limit benefits, although it is possible that they could charge them more if their child has such a condition.

Based on regulations released by the Administration earlier this week, families shopping for plans may also face "open enrollment" periods. (See Administration's fact sheet addressing "open enrollments.)  Insurers want to curb the practice of people signing up for coverage only when they become sick.  But the effect could result in children having greater difficulties obtaining coverage when they most need it. Federal officials need to ensure that "open enrollment" policies include strong protections for kids, including making sure that children cannot be improperly dropped from coverage and that a child can bypass the enrollment period at critical junctures, such as when a child loses employer, Medicaid/CHIP or other coverage.

The website also has information on the new high risk pools, which are established in every state to provide affordable coverage to people who've been uninsured because of a pre-existing health condition.  For some families, if they can show their child was either denied coverage or charged an excessive amount for a policy, and has been uninsured for at least 6 months, these new high risk pools could be a viable option.  Federal officials could also revisit the pools' eligibility requirements to ensure that sick children facing a loss of coverage can access care without having to wait 6 months. Additionally, state and federal officials running the pools need make sure the application and enrollment process for these kids is simple and accessible, and that the benefits effectively meet children's unique health care needs.

Over the coming weeks and months, it will be critical for state and federal officials, as well as advocates for children and families, to closely monitor health insurance companies and cry "foul" against any business decisions that could negatively impact kids.

Of course, in 2014, when the full range of health insurance reforms are implemented, many more options will become available.  And the dysfunctional insurance industry model that denies millions of families access to coverage when they need it the most will hopefully be a thing of the past.

For more information, see answers to some frequently asked questions, available here. 

Summer vacation is not even half over and I'm already thinking about getting my kids ready to go back-to school.  It's not that I don't enjoy their company; I just want to get a jump-start on my to-do list so that I deliver them to school ready to learn.  Along with back-to-school shopping, they need their annual physicals and 6-month dental check-ups.  Child health advocates around the country have another major item on their back-to-school checklists - reaching out to the five million children who are eligible for Medicaid or CHIP but are unenrolled. 

This is an ideal time of year as the media and huge segments of our population are focused on children's needs as they prepare to head back to school. The National Covering Kids and Families Network (NCKFN) is helping groups leverage the increased attention to children's issues during the back-to-school period to help reach enroll eligible children in state Medicaid and Children's Health Insurance Program plans. They recently hosted a webinar to discuss messaging and strategies that work. (Georgetown CCF is providing technical assistance to NCKFN). 

Many of the NCKFN participants and other groups have been working on back-to-school efforts for many years and had a wealth of experience to share with each other. Some excellent messages have been developed for groups working on this initiative by GMMB with the support of the Robert Wood Johnson Foundation.  The trick is getting the right messengers to use the messages to reach families of uninsured children. Many of the NCKFN groups have had a lot of success working with school nurses, school administrators, social workers, community outreach workers and teachers. Two participants on the webinar focused on more non-traditional messengers - school board members and youth sport leaders. 

First, Donna Cohen Ross, senior advisor to the Office of External Affairs at CMS (and an expert on outreach), announced HHS's plan to launch a coaches campaign "Get Covered: Get in the Game" which will enlist youth sports leaders to help find uninsured children and get them enrolled (more details on the campaign to come in August). Coaches are great messengers.  (Just compare the sports section to the health section of your local newspaper if you doubt the ability of sports leaders to get a message across in your community.)  Coaches can pitch a different message to families by linking the importance of coverage with the ability to compete in team sports. As Donna pointed out, there is a strong link between good health care and sports as kids frequently are excluded from school sports participation if they don't have a physical.  Parents are also understandably reluctant to allow children to participate in sports if they aren't insured for fear of an injury that they can't afford to treat. 

As the mother of three boys, I'm involved with my fair share of youth sports teams and recall one heart-breaking incident when one of my son's soccer teammates suffered a concussion during a tournament.  I offered to drive him and his mother to the hospital but she said she didn't have insurance so she would just wait to see if he really needed care.  No mother should be faced with that choice and coaches could help make sure they are not.  Good coaches teach children more than just about sports, they teach them about the importance of teamwork, perseverance, and hard work and they make sure kids are doing as well off the field as they are doing on the field.   Youth sports participation helps children learn many valuable life lessons and it is tragic that some children are unable to fully participate in this aspect of childhood due to the lack of insurance coverage - especially for those who are eligible but unenrolled in CHIP or Medicaid. 

Second, April Griffin, a school board member from Hillsborough School District in Florida, spoke about the importance of getting buy-in at the top. (In other words - cultivating the grass tops as well as the grass-roots).   She pointed out that school district staff and teachers are stretched thin and are under pressure to raise test scores.  According to Ms. Griffin, the more groups are able to link children's health coverage with school performance, the more successful they should be in getting the buy-in of school system personnel. 

Her message also hit home.  A friend of mine tried to get our school district to include information about our state's Medicaid and CHIP programs in back-to-school packets.  The school district staff refused and said it was against school district policy.  My friend appealed to a school board member by pointing out that the school district included promotional materials of for-profit insurance companies in the packets.   The school board member was able to look at the "big picture" rather than reading a policy manual and gave the staff person the go-ahead to include the CHIP & Medicaid information in this fall's packets. 

There were a lot more great ideas shared on the NCKFN webinar and I encourage readers to check them out here.  In collaboration with the network, Donna Cohen Ross of CMS has scheduled a second webinar on school-based outreach efforts on July 29th. (All those of you who have read Donna's posts on this blog or have worked with her over the years know that Donna cares deeply about this topic and you won't want to miss this opportunity.)   

Last week, the National Association of Insurance Commissioners held a first of many planned meetings on health care reform.  In many ways, state insurance commissioners, have become the front lines of health reform implementation as they are responsible for ensuring that health plans are compliant with the insurance reforms in the Affordable Care Act and they will play a key role in the establishment of the exchanges.

For this meeting, at the top of the agenda was the exchanges and the discussion ran the gamut, from basic questions about exchange responsibilities to detailed analysis of how to limit adverse selection. The consumer perspective was well represented with our colleague at the Georgetown Health Policy Institute, Sabrina Corlette, who testified along with Tim Jost of Washington and Lee University. Tim shared his view that the success of an exchange will depend greatly on its ability to establish a streamlined enrollment and eligibility system that is seamlessly linked to Medicaid and CHIP.

Interestingly, the issue of coordination between the exchanges and Medicaid and CHIP brought forth many questions from the represented commissioners. More than once we heard reference to the fact that public programs, and the populations they serve, are a new world for insurance commissioners and that they are eager for more information. Key issues on their minds were how to maintain continuity of care between those moving back and forth between exchange and Medicaid/CHIP coverage, what IT funding and/or technical assistance will be available to assist Medicaid/CHIP agencies, and how to align the more "prescriptive" eligibility rules of Medicaid/CHIP with the tax credits so that enrollment in exchanges is consumer friendly.

The conversation was a good start - but also a good opening for ongoing dialogue with and education to state insurance commissioners on the central role that exchanges will play in helping people to secure subsidies for coverage and in facilitating their enrollment into Medicaid and CHIP. Georgetown CCF submitted comments to the NAIC on these critical issues.

For the meeting agenda and other materials, visit the NAIC site.