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Meet the Enrollment Assisters

August 22, 2013


Navigators. In-Person Assisters. Certified Application Counselors (CACs). Brokers and Agents. These are the people who will help consumers understand their coverage options and enroll in Affordable Care Act Marketplace insurance. The Affordable Care Act's success is based on the premise of participation by everyone.

Thus, enrollment workers will need to focus on both Marketplace private health insurance coverage (including the provision of information about tax credits and subsidies) and Medicaid expansion. See below to learn more about this army of many names, whose unshared job titles are partially a function of legislative detail.

Choosing coverage is not to be taken lightly. Ryan White clients will need wise counsel to help decide on plans that are not only affordable but also work best for people living with HIV/AIDS.

Among the agencies receiving specific funding to conduct enrollment assistance are various HIV/AIDS-related agencies, such as AIDS Alabama, AIDS Foundation of Chicago, Utah AIDS Foundation, Whitman Walker Health in DC, and--in California--Bienestar and the LA Gay and Lesbian Center. It's hard to keep track of how many others as enrollment assistance funding channels are varied. Agencies will be enrolling broad populations, not just persons living with HIV/AIDS. Based upon the experience of Massachusetts with state health care reform, helping consumers enroll and then retain coverage is challenging work.

Most Ryan White agencies will be busy helping clients transition to new coverage options, although probably not with special enrollment funding. There is ample flexibility around the use of HRSA Ryan White grant funds to provide outreach, enrollment, and benefits counseling. Their work is crucial as choosing coverage is not to be taken lightly. Ryan White clients will need wise counsel to help decide on plans that are not only affordable but also work best for people living with HIV/AIDS (see the Enrollment Mantra). A July 2013 Kaiser Family Foundation national roundtable discussion emphasizes this point.

Navigating by Ryan White

Both AIDS Alabama and AIDS Foundation of Chicago are conducting enrollment assistance in their respective states through collaborative teams of agencies. AIDS Alabama, a Part B sub-awardee, received navigator funding in mid-August to provide enrollment assistance across the state. (Navigators are for those states not running their own Marketplaces.) AIDS Alabama has an enrollment target of 500 individuals per month, primarily those between 100% of the federal poverty level ($11,490 for a single person in 2013) up to 400%.

These are the individuals eligible for tax credits/subsidies in states not expanding Medicaid eligibility. Transitions to Medicaid will be very limited as Alabama is not expanding Medicaid and is retaining its current eligibility standards. AIDS Foundation of Chicago, on the other hand, is targeting a very low income population in a state, Illinois, that is expanding Medicaid eligibility and will thus do more Medicaid enrollment assistance.

A significant proportion of Ryan White clients in Alabama are set to transition to individual health insurance coverage. AIDS Alabama's social workers are using an insurance marketplace pre-screening tool developed in North Carolina to project how many clients will be transitioning so they can be ready for the October 1 launch of open enrollment season. AIDS Foundation of Chicago is using the same pre-screening tool, modified for a Medicaid expansion state.

Lauren Banks, AIDS Alabama's Director of Policy and Advocacy, says that navigators are awaiting release of Qualified Health Plans (QHPs) by the state and will become "experts on these plans." Adds Banks, "As navigators, we really have to be objective but we can absolutely [work with clients] to say this plan will probably work best for your needs. Once we are trained by CMS, we will learn how to approach" plan selection. AIDS Alabama will be convening numerous community events, home visits and "as many presentations as possible," with a goal to build trust within the community as a step toward getting people to sit down with a navigator and enroll.

Ryan White and Coverage Completion

Enrollment assistance provided to Ryan White clients will be much the same as that offered to everyone in terms of reviewing plan options to match individual health needs, meet usage preferences (e.g., participating providers), and manage costs. However, additional considerations unique to Ryan White clients include whether to pick plans that let them stick with their Ryan White clinicians and choosing plans that bring Ryan White premium and cost-sharing assistance.

Both grantees and clients also need to determine how Ryan White can help with premiums and out-of-pocket costs that are associated with Marketplace coverage options. Grantees will need to figure this out in relation to their Ryan White budgets. Clients will need guidance from enrollment assisters who know what Ryan White will provide. In other words, Ryan White clients will probably benefit most by getting enrollment counseling from their Ryan White providers.

Fortunately, most Ryan White grantees have staff--social workers, case managers, benefits counselors--who have experience helping clients with eligibility and enrollment. Depending on the agency and the state, many of these staff are familiar with Medicaid and private insurance plans, given that most Ryan White clients have public or private insurance, even before Affordable Care Act implementation. Regardless, new training will be necessary, according to Banks. "This is going to be a new system… It's a whole new ball game."

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