Case managers as connectors, educators, advocates in the new insurance marketplace

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1 Case managers as connectors, educators, advocates in the new insurance marketplace Mandy Cohen, MD Senior Advisor to the administrator Centers for Medicare & Medicaid Services Patrice Sminkey Chief Executive Officer Commission for Case Manager Certification 1 Proprietary to CCMC

2 Agenda Welcome and Introductions Learning Objectives Patrice Sminkey, CEO, the Commission Mandy Cohen, MD, Senior Advisor to the administrator Centers for Medicare & Medicaid Services Question and Answer Session 2

3 Audience Notes There is no call-in number for today s events. Audio is by streaming only. Please use your computer speakers, or you may prefer to use headphones. Please use the chat feature on the lower left-hand part of your screen to ask questions throughout the presentations. Questions will be addressed as time permits after both speakers have presented. A recording of today s session will be posted within one week to the Commission s website, One continuing education credit is available for today s webinar only to those who registered in advance and are participating today. 3

4 Learning Objectives Overview After the presentation, participants will be able to: Identify the type of state or federal health insurance marketplace their clients will be able access, and how to contact the navigators who can support client decision making; Communicate to clients the essential information they need to access new health insurance coverage in the new insurance marketplaces; and Generate a plan for communicating with health insurance marketplace navigators in your case management service area. 4

5 The Case Management Knowledge Framework Patrice Sminkey Chief Executive Officer Commission for Case Manager Certification

6 The Case Management Knowledge Framework 6

7 A framework for EVERYONE 7

8 7 Essential domains Case Management Concepts Principles of Practice Health Care Management & Delivery Health Care Reimbursement Psychosocial Aspects of Care Rehabilitation Professional Development & Advancement 8

9 9 Phases of CM Process Screening Assessing Stratifying risk Planning Implementing (care coordination) Following up Transitioning (transitional care) Communicating Post-Transition Evaluating 9

10 The Case Management Knowledge Framework 10

11 Case managers as connectors, educators, advocates in the new insurance marketplace Mandy Cohen, MD Senior Advisor to the administrator Centers for Medicare & Medicaid Services Motivational Interviewing: Engaging Patients Through Communication 11

12 The Health Insurance Marketplace 101 Mandy Cohen MD, MPH Centers for Medicare and Medicaid Services September 2013

13 The Health Insurance Marketplace The Marketplace (or Exchange) Place for individualsand small employers to get private health insurance options 90% of people who are currently uninsured will qualify for discounted or free health insurance A new way to get health insurance Enrollment starts October 1, 2013 Coverage begins January /18/13 13

14 Marketplace Establishment Each state can choose between: State Based Marketplace State creates and runs its own Marketplace State Partnership Marketplace State partners with Federal government to run some Marketplace functions Federally Facilitated Marketplace State has a Marketplace established and operated by the Federal government 9/18/13 14

15 Marketplaces Federally Facilitated Marketplace Conditionally Approved State Partnership Marketplace Alabama Ohio Arkansas California Alaska Oklahoma Delaware Colorado Arizona Pennsylvania Illinois Connecticut Florida South Carolina Iowa DC Georgia South Dakota Michigan Hawaii Indiana Tennessee New Hampshire Idaho Kansas Texas West Virginia Kentucky Louisiana Virginia Maryland Maine Wisconsin Massachusetts Mississippi Wyoming Minnesota Missouri Nevada Montana New Mexico Nebraska New York New Jersey Oregon North Carolina Rhode Island North Dakota Utah Vermont 9/18/13 Conditionally Approved State Based Marketplace Washington Total: 26 Total: 7 Total: 18 15

16 Small Business Health Options Program (SHOP) SHOP is a Marketplace for small businesses and their employees (fewer than 50 employees) Eligible employers can Define how much they ll contribute toward their employees coverage Have exclusive access to a small business tax credit Benefit from new protections that help them get real value for consumer s premium dollars 9/18/13 16

17 Medicaid Expansion States have the option to expand Medicaid eligibility to adults ages with incomes below 133% of the Federal Poverty Level (FPL) 100% federal funding for newly Medicaid eligible States have no deadline to decide if they are going to expand One streamlined application for Medicaid or private health plans Shifts to simplified way of calculating income to determine Medicaid/CHIP eligibility Known as Modified Adjusted Gross Income (MAGI) 9/18/13 17

18 Eligibility and Enrollment Marketplace initial open enrollment period starts October 1, 2013 and ends March 31, 2014 Coverage begins January 1 st 2014 Marketplace eligibility requires consumers to Live in its service area, and Be a U.S. citizen or national, or Be a non-citizen who is lawfully present in the U.S. for the entire period for which enrollment is sought Not be incarcerated 9/18/13 18

19 Advantages of the Marketplace Helps enhance competition in the health insurance market Increases Affordabilitythrough premium tax credits, cost sharing reductions, or public insurance programs Ensures Quality though QHPs that must meet basic standards, including quality standards, consumer protections, and access to an adequate range of clinicians Makes Costs Clearby providing information about prices and benefits in simple terms consumers can understand, so they don t have to guess about costs 9/18/13 19

20 APPLICATION AND ELIGIBILITY Eligible for Marketplace or Medicaid/CHIP Enroll (Marketplace) Online Phone Mail In-Person Supported by Data Services Hub Enroll (Medicaid/CHIP)

21

22 Enrollment Assistance Call 24x7 Support for 150 Languages In Person Medicaid/CHIP Online/phone/in person Written Applications in English/Spanish Notices & letters Online 24x7 Webchat English/Spanish site User Account Assistance API available for other sites Syndicated content Mobile 24x7 & text updates Plans Payment online/phone Ongoing customer service 22

23 Help to Pay Qualified Health Plan Costs Based on family income and size Premium discount Family of four with annual income $23,550* $94,200* or less And not eligible for certain other insurance coverage like Medicaid Lower cost-sharing (like copays) Family of 4 with annual income $58,875* or less (some other restrictions) *2013 amounts 9/18/13 23

24 Payments with Your Tax Returns In 2014 If you don t have a certain level of health coverage (employer coverage, Medicare, Medicaid, CHIP, TRICARE, certain VA coverage, an individual policy, or a plan in the Marketplace) you may have to make a payment with your tax return Starting when you file your 2014 Federal tax return in 2015 Some people may qualify for an exemption 9/18/13 24

25 Are all employers required to provide health insurance in 2014? Employers averaging fewer than 50 Full Time Employees (FTEs) are not required to provide health insurance coverage 96% of all employers in the U.S. have fewer than 50 employees Employers with an average of 50 or more FTEs may be subject to a shared responsibility payment under certain conditions starting in /18/13 25

26 The Health Insurance Marketplace Enrollment October 1 st, 2013 March 31 st 2014 Coverage begins Jan 1 st, % 133% 400% FPL Our goal is to ensure Americans have quality, affordable health coverage. 9/18/13 26

27 Home Page Get Insurance tab 9/18/13 27

28 National Snapshot 41 million eligible uninsured 17.8 million years olds 58% male 26% Latino 18% African American Poverty Level 50% of the uninsured live in 8 states California, Texas, Florida, New York, Georgia, Illinois, Ohio and North Carolina HHS has primary responsibility for outreach in 29 states 20% have not graduated High School 3.8 million rely on Spanish One million rely on some other language 9/18/13 28

29 Reaching the Uninsured: Earned & Paid Media; Partnerships Broadcast and Print Media -regional/local media in top markets as well as key national outlets and publications. Digital Media Proactive info graphics/video series. Leverage social media to disseminate content Specialty Media African American and Spanish Language media, as well as key outlets to reach the small business and provider communities. National and Regional events -drive coverage nationally and locally in conjunction with key announcements and program milestones. Paid Media and Paid Media Partnerships -Radio, TV, Digital, Local Print & Outdoor Partnerships cultivating public and private partnerships to assist with outreach, education and enrollment 9/18/13 29

30 Reaching the Year Old Uninsured Effective Messaging Effective Messengers Media Habits Find a plan that fits your budget Health care you can afford and count on when you need it Financial help may be available to lower your monthly health premium All information about what every plan covers and how much it costs is in one place Family -moms, friends, doctors, nurses, pharmacists. 91% use internet (but not for health information) More likely to watch TV (Galavision, Tres, BET, MTV, G4, Spike, Oxygen, Style) Source: CMS and GMMB Market Research

31 Ways to Help Sign up to be a Champion for Coverage Direct individuals to HealthCare.govto sign up for and text alerts. Direct individuals to the call center at available 24/7 in 150 languages Use materials available now for download at Marketplace.cms.gov Order printed copies of consumer materials to share with your community at 9/18/13 31

32 Ways to Help Host a webinar/teleconference/in-person format to talk about the Marketplace. PowerPoint slides, talking points and other educational materials at marketplace.cms.gov Post the Marketplace widgetson your website or in your signature. Connect through social media: Facebook.com/HealthCare.govFollow Healthcare.gov on Take advantage of Free CME via Medscape 9/18/13 32

33 Marketplace.cms.gov Widgets Banner/Backdrop Shop Health Here video Testimonial video Barista Talkers/PowerPoint Drop-in articles Op Ed Postcard for /list serv sign-up Consumer Get Ready checklist Collateral brochures Customizable flyer PSA/Live Reads Infographics Ordering info Postcards Collateral brochures Shop Health Here Video 9/18/13 33

34 Other Resources 10 Things Providers Need to Know things-providers-need-to-know.pdf 10 Things to Tell Your Patients things-to-tell-your-patients.pdf The YouToons Get Ready for Obamacare: Health Insurance Changes Coming Your Way Under the Affordable Care Act 9/18/13 34

35 Thank you! Question and Answer Session Commission for Case Manager Certification Commerce Parkway, Suite C Mount Laurel, NJ Corporate: Proprietary to CCMC

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