Texas Well and Healthy

This op-ed ran in the Austin American-Statesman in advance of a Congressional hearing in Dallas about implementation of the Affordable Care Act and the role of navigators, who help people enroll in health insurance.

Back in 2009 Lieutenant Governor David Dewhurst made an emphatic endorsement for increasing the number of children enrolled in the Children’s Health Insurance Program. “If I had a magic wand, I’d get them all enrolled in the CHIP program,” he said. “Why? I think that at the end of the day, it’s the moral thing to do, and in the long run, the most economical thing to do.”

The moral and economic incentives for maximizing enrollment are there for both moderate-income children who qualify for CHIP and lower-income kids eligible for Children’s Medicaid. Both CHIP and Children’s Medicaid help children hit important developmental milestones, enter school ready to learn and get check-ups and treatment they need. Health coverage supports families, staving off bankruptcies that can come from unexpected medical expenses. Improved coverage also supports communities, reducing the number of uninsured and all the costs that typically get passed on to others, to be paid for through higher premiums and fees on health services.

We have a unique opportunity right now to make this critical asset more available to Texas children than ever before. For the first time, nearly all Texas children are eligible for coverage-whether through CHIP, Medicaid or the new Health Insurance Marketplace.

Since the roll-out of the Affordable Care Act, more families have found out what’s available to them, and more are looking at their options leading up to a Dec. 23 deadline for enrolling in coverage that kicks in at the start of the new year. Most families who are purchasing coverage for their children in the new health insurance marketplace also will receive financial assistance to help pay for health insurance. As more Texans learn about their options and get their kids enrolled, our state’s uninsured child rate-the second-highest in the nation-could easily plummet.

That won’t take a magic wand, but it will take allowing the health law to work as intended. For example, our state should make sure that enrollment experts through the navigator program can do their jobs without excessive restrictions while still maintaining common sense consumer protections. Applying for health coverage is daunting, and we shouldn’t be making it harder for people to get the information they need to learn about their options and sign up.

Similarly, our state leaders should oppose red tape to health coverage for children. The Affordable Care Act eliminated some of the hoops that Texas families must jump through, and our state leaders should stop fighting the removal of these barriers within Medicaid.

We can also hold strong in areas where we have made progress. Foster youth who leave state care, without ever having been adopted, are some of the young adults most vulnerable to poor health and life outcomes. Maintaining their health coverage options as they leave care is a way of safeguarding these youth and putting them on a better trajectory. Our state administration is currently proposing eroding these benefits for some former foster children, leaving young adults who have no family support to fend for themselves.

Finally, Texas can stop standing in the way of whole family coverage. Roughly 1 in 3 adults who aren’t seniors are uninsured, and many hard-working, low-income parents have no affordable options for health insurance. As a result, researchers say, many also won’t know about the options available to their children. One of the best things our state can do to support families’ economic security and their health is accepting a way to get every family member the coverage they need. The state still has the opportunity to connect Texas families to expanded eligibility in the Medicaid program if it chooses to.

Our state’s delay in accepting this expansion has left federal funds on the table and created a coverage gap for hundreds of thousands of working parents in Texas. A recent report sponsored by the Commonwealth Fund found just how costly it will be to continue to delay coverage expansion. Through 2022, the cost to Texas taxpayers of this delay will be over $9 billion. That will result in fewer jobs created and fewer resources flowing through our local communities.

Texas is making progress, but more than a million kids in the Lone Star State remain uninsured. Meeting our state’s moral obligation and maximizing opportunity for our state’s economic future doesn’t require a magic wand. It requires the resolve to let our federal laws function as intended and continued investments in coverage approaches like CHIP and Medicaid that work.

Written by Clayton Travis, Hogg Mental Health Policy Fellow at Texans Care for Children. Cross-posted from Texans Care for Children Newsroom.

Last week, the Texas Department of Insurance released proposed rules on “navigators”—community organizations like the United Way that help uninsured people apply for health insurance. As proposed, the rules could prevent or delay the important work of navigators. Fort Worth Star Telegram editors agree, noting that the rules will impede insurance enrollment and hinder progress on reducing Texas’ worst-in-the nation uninsured rate.

But, there are many good provisions in the rules as well. They could work as intended—to increase consumer protections without hindering the vital work of trained and certified navigators—if the department modifies the proposed rules to address the key concerns listed below.

The rule could prevent a navigator from helping consumers understand and compare the benefits so that consumers can make an informed insurance choice. Explaining and comparing the features of different health plans (the premium, deductible, provider network, covered medications, etc.) is NOT the same thing as recommending a consumer buy a specific plan. Navigators need to be able to help consumers compare and understand insurance options, without recommending which plan to purchase.

The rule could shut down navigator services as of March 1, when demand will spike in the final month of open enrollment. As proposed, navigators must comply with the rule by March 1, 2014. Once the rule is final, navigators could have just a month (or less) to jump through many hoops. This timeline is too short for navigators to accomplish at least two time-consuming, bureaucratic necessities that are completely outside of navigators’ control:

1. obtaining advance federal permission to deviate from the navigator’s grant budget finalized back in August (processing takes 30-60 days), and
2. getting through TDI’s registration system (processing could take 2-3 weeks).

When you combine these steps with the other hurdles navigators have to clear to come into compliance, the full process could take three months. The rules should ensure that navigators can continue to provide their vital services while they work in good faith toward compliance.

Nonprofit navigators will have to pay excessive and unnecessary fees for the privilege of providing free application assistance to the poor and uninsured. TDI estimated some of the various costs imposed for compliance could add up to to $900 per individual navigator, on top of an additional $1,400 per navigator organization. A navigator organization that oversees 30 navigators could incur about $30,000 in costs in the first year—possibly about enough to support a full-time navigator. Every dollar diverted from enrollment assistance leaves fewer resources to serve Texas’ 6.4 million uninsured.

The 40-hour state training requirement (on top of the 20-30 hour federal training requirement already fulfilled by Texas navigators) is excessive and unjustified. TDI’s rules require 60-70 hours of total training for ACA navigators, and the agency says extra state training will cost navigators $200-$800 per person. ACA navigators will be held to a much different standard than HHSC Medicaid/CHIP navigators and other community-based enrollment assistors, who perform very similar services. For example, it takes about four hours to complete the free HHSC navigator training that prepares community groups to help people enroll in Medicaid, CHIP and other programs through the Community Partner Program. Community Medicare counselors in HICAP (also certified by TDI) receive 25 hours of free training.

The rule applies well beyond navigator grantees under the Affordable Care Act. For example, the proposed rule would require a mother helping her young adult son with an application for insurance to first complete an expensive and time-consuming registration with the state. The rule would also prevent organizations and individuals who provide basic information on health coverage programs (including the ACA, Medicaid, or CHIP) from using the term “navigator” as a job title if they do not go through the state registration process. Many health care-related organizations use the term “navigator” today (like patient navigators and cancer navigators) to describe the individuals who help patients understand and connect with health care and coverage.

We have created a flowchart to help organization and individuals determine if TDI’s proposed rules will affect them, and we plan to release additional resources related to the proposed navigator rule over the next few weeks. Make sure to check our website for these updates.

TDI is accepting public comments on the proposed rule through January 6, 2014. Written comments submitted via email must be sent to both [email protected] and [email protected]. Or you can provide written or oral testimony at either of the two hearings TDI is holding on these rules in Austin on December 20 and January 6.

Written by Stacey Pogue, Center for Public Policy Priorities. Cross-posted from Better Texas blog.

Navigators are organizations and individuals who are trained, certified, and funded by the federal government to help people enroll in coverage options through the Marketplace, including private insurance, Medicaid and CHIP. Insurance is difficult to understand, especially for people who haven’t had it before. Navigators provide in-person help—answering questions, deciphering plan options, and helping people enroll. Their help is crucial in a place like Texas, with more than 6 million uninsured individuals.

Texas is one of 17 states that have passed laws to place additional state restrictions or standards on top of uniform federal standards. The Governor instructed the Texas Department of Insurance (TDI) to write rules to place potentially onerous (and possibly illegal) restrictions on navigators in Texas. TDI responded by reviewing, as required by the Texas law, the federal navigator program. On Friday, November 15, TDI released a summary of potential insufficiencies in the navigator program that could be addressed in state rule. TDI asked for comments on the summary by 5 p.m. Friday, November 22. TDI has not yet initiated a formal rulemaking process.

At CPPP (one of the four partner organizations behind the Texas Well and Healthy Campaign), we are still digesting TDI’s summary, but want to highlight a few items:

• TDI seeks to regulate entities and people who help individuals complete the single, streamlined application for coverage used by the Marketplace, Medicaid and CHIP, whether or not they are associated with a federal navigator grant recipient; however, TDI exempts entities or individuals regulated under separate state or federal law. Certified Application Counselors will not be subject to TDI oversight. Organizations participating in the Community Partner Program and HICAP programs also appear to be exempt.
• Individuals who are just helping their children, parent, neighbor, or friend apply for coverage (but who are not soliciting enrollment assistance to the public) do NOT appear to be exempt. It would be unreasonable to expect people who help a family member or neighbor fill out an application at their kitchen table to register with the state. It is possible that people who help their family and friends apply and take the additional step to become an “authorized representative,” as provided for in federal regulation for the Marketplace, Medicaid, and CHIP, would be exempt.
• Individuals subject to TDI oversight will have to register with the department , pay fees, and possibly incur expenses related to: registration, fingerprinting, a background check, a state-issued ID, additional training in Medicaid and HIPAA, and examinations.
• Navigator entities will have to buy a surety bond to protect individuals against errors. Reports from other states indicate that no one is selling surety bonds to navigators. If they simply aren’t for sale, this requirement could pose an impossible hurdle. Furthermore, federal regulations clearly pre-empt state requirements that navigators hold errors and omissions insurance. While the federal rules do not specifically address mandatory surety bonds, such a requirement certainly violates the spirit, if not the letter, of federal law.
• Part 5 of the summary appears to prevent certain individuals who perform some navigator services from using the term “navigator” in their titles or as part of an entity’s name or website, which could prove problematic because the term navigator is used widely and was in use before ACA passage.

CPPP hopes to work with TDI to advance appropriate standards to protect consumers without limiting access to critical navigator services.

Written by: Stacey Pogue, Center for Public Policy Priorities. Cross-posted from Better Texas Blog.

The Affordable Care Act roll-out online has been rocky, it’s true. But the HealthCare.gov website is only part of a much bigger law that many Texans understand will bring affordable health coverage to millions of people who need it.

In Texas, many of us are uninsured or have been “uninsurable” because of a pre-existing condition. The most important part of the health law-the part that makes good insurance available, regardless of health history and at prices families can afford-is working just fine. Getting Texans covered is still the end game, so let’s keep in mind three things.

1. Patience will be rewarded. Texans have until December 15 to enroll in coverage that begins on January 1, and the enrollment period lasts through March. Officials are working to iron out the kinks as quickly as possible. In the meantime:

2. This is a good time to get prepared. If you’re thinking of enrolling, use this time to gather what you’ll need:

• Have you got your paperwork together? You’ll need a Social Security or immigration number for everyone in your household enrolling and the previous year’s tax return (or a W2 or pay stub) to enroll.
• Have you set up an account? You can do so by phone with little wait time. The number is 1-800-318-2596.
• Have you found out about financial assistance you qualify for? A resource from the Kaiser Family Foundation calculates an estimate for you.
• Have you browsed the plans available to you? The best place to do so is at this HealthCare.gov page. You can also get some sense of prices and your options using tools from Get Covered America and the Texas Tribune.
• Have you met with someone? A navigator or certified application counselor can assist you in talking through your options and getting enrolled. Find one near you here.

3. Keep some perspective: This is the first time a website of this scale, able to do these things, has ever been tried. Still, it isn’t the first time a change in health policy has been slow getting out of the gate before making a positive difference in millions of lives. Medicare Part D, the CHIP program and Medicare and Medicaid all had bumpy beginnings, but each is widely accepted and appreciated now. The Affordable Care Act will get there, too, as more people enroll.

Written by: Christine Sinatra, Texans Care for Children

A recent letter from Governor Perry directs the Texas Department of Insurance to place unwarranted restrictions on navigators, many of which would violate state and/or federal law.

Navigators are people and groups trained and certified to provide in-person assistance to Texans learning about their health care options and enrolling in the new health care marketplace. Eight organizations in Texas are in the process of receiving their navigator training and certification to help Texans enroll in health plans.

This letter is yet another politically motivated effort to derail ACA implementation in Texas, and keep low-income and middle-class Texans from getting enrolled in new, more affordable coverage starting in October.

Navigators will help uninsured Texans get enrolled, and their role is vital. With 6 million uninsured Texans, we need an all-hands-on-deck approach to enrollment starting in October. Navigators will fill a critical need by providing knowledgeable in-person assistance through familiar and trusted community groups, to help people apply and sort through new coverage options.

Navigator-type programs are a tried-and-true concept that haven’t stirred controversy in the past. In Medicare, the State Health Insurance Assistance Program (the Health Information, Counseling and Advocacy Program or HICAP in Texas) has been in place assisting seniors for more than two decades. And community partners who assist with outreach and enrollment have been a key part of covering children in Texas Medicaid and CHIP.

Our state has a long, successful history of partnering with informed community-based groups to help people enroll in health insurance like Medicaid, CHIP and Medicare. Just as there are protections in place for our existing assistance providers, our new navigators will be subject to thorough training, certification and oversight.

• Navigators will offer knowledgeable, in-person assistance to consumers and small employers and help them learn about their coverage options in Texas. Selected to also assist with outreach to underserved groups, the navigators include United Way organizations in El Paso and Tarrant County, the East Texas Behavioral Health Network, Migrant Health Promotion in the Rio Grande Valley, the Urban League and others.

• Demand for navigators is high, and the law takes their role seriously. In national polls, 75 percent of people who would be eligible for coverage in the marketplace indicated interest in receiving in-person assistance to learn about and enroll in coverage.
• The Affordable Care Act puts rigorous training and oversight standards in place for navigators.

• Federal rules for navigators address privacy directly and prohibit the use of consumers’ personal accounts or information without the consumer’s involvement.

What has worked for Texas seniors and families with children can also be effective for Texans learning about their coverage from navigators. Texans will be able to locate these trained and certified authorized assistance providers listed on www.healthcare.gov when seeking help with enrollment. Groups awarded grants were subjected to screening as part of the grant application process to ensure they meet standards, and all individuals authorized to assist with Texans’ enrollment in the marketplace will have to meet standards and receive training and certification that includes privacy and security standards.

As Texas Well and Healthy partner Katrina Mendiola, the executive director of Engage Texas, said in a press release: “Officials keep trying to sow doubt about the Affordable Care Act, but the law is well on its way to helping millions of our nation’s uninsured receive the health care they need. What Texans need to know is there will be experts—who are screened and authorized to help—ready to help them find out about their health care options and get enrolled on October 1.”

– Texas Well and Healthy Campaign staff report

Today members of the Texas Well and Healthy campaign released a statement, celebrating the awarding of federal grants for “navigators,” the people and groups certified to provide in-person assistance to Texans learning about their health care options and enrolling in the new health care marketplace. Eight organizations will receive training and certification to help Texans enroll in health plans. From our statement today:

Navigators will help uninsured Texans get enrolled.

“With 6 million uninsured Texans, we need an all-hands-on-deck approach to enrollment starting in October,” said Stacey Pogue, a senior policy analyst at the Center for Public Policy Priorities. “Navigators will fill a critical need by providing knowledgeable in-person assistance through familiar and trusted community groups, to help people apply and sort through new coverage options.”

“Our state has a long, successful history of partnering with informed community-based groups to help people enroll in health insurance like Medicaid, CHIP and Medicare. Just as there are protections in place for our existing assistance providers, our new navigators will be subject to thorough training, certification and oversight,” said Anne Dunkelberg, interim executive director at the Center.

• Navigators will offer knowledgeable, in-person assistance to consumers and small employers and help them learn about their coverage options in Texas. Selected to also assist with outreach to underserved groups, the navigators include United Way organizations in El Paso and Tarrant County, the East Texas Behavioral Health Network, Migrant Health Promotion in the Rio Grande Valley, the Urban League and others.

• Demand for navigators is high, and the law takes their role seriously. In national polls, 75 percent of people who would be eligible for coverage in the marketplace indicated interest in receiving in-person assistance to learn about and enroll in coverage. The Affordable Care Act put high standards in place for navigators and certified application assisters and creates a system of oversight.

• Federal rules for navigators address privacy directly and prohibit the use of consumers’ personal accounts or information without the consumer’s involvement. What has worked for Texas seniors and families with children can also be effective for Texans learning about their coverage from navigators and certified application assisters. Texans will be able to locate these trained and certified authorized assistance providers listed on www.healthcare.gov when seeking help with enrollment. Groups awarded grants were subjected to screening as part of the grant application process to ensure they meet standards, and all individuals authorized to assist with Texans’ enrollment in the marketplace will have to meet standards and receive training and certification that includes privacy and security standards.

Yesterday, in advance of today’s scheduled announcement about grant recipients, Texas Attorney General Greg Abbott sent a letter to US Health and Human Services Secretary Kathleen Sebelius about privacy considerations and the navigators program.

“Officials from Texas and the other states that are involved keep trying to sow doubt about the Affordable Care Act, but the law is well on its way to helping millions of our nation’s uninsured receive the health care they need,” said Katrina Mendiola, executive director of Engage Texas. “What Texans need to know is there will be experts—who are screened and authorized to help—ready to help them find out about their health care options and get enrolled on October 1.”

###

Texas Well and Healthy is a grassroots campaign to improve health care access for Texans. It is a project of the Center for Public Policy Priorities, Engage Texas, Children’s Defense Fund – Texas and Texans Care for Children, in conjunction with the broader Cover Texas Now coalition.

Three of four people who will be eligible for coverage through the new online health insurance marketplace opening in October say they want in-person assistance to help them learn about and enroll in coverage. Navigators—in-person assistance providers who will help consumers and small employers enrolling in the marketplace—are one of the ways the Affordable Care Act addresses this demand. Navigators will also be able to tailor outreach efforts to marketplace enrollees who, compared to people who are insured today, are more likely to be lower income, less educated, more racially and ethnically diverse, and more likely to speak a language other than English.

Today, the U.S. Department of Health and Human Services released its Funding Opportunity Announcement (FOA) for ACA Navigators in federally facilitated or state partnership exchanges. U.S. HHS encourages all applicants to submit a letter of intent (optional) by May 1, 2013 to [email protected]. Final applications are due by 1 p.m. (EDT) on June 7, 2013 through grants.gov. Awards will cover a 12-month period of performance following the anticipated August 15, 2013 award date.

The total $54 million award will be distributed among the 34 eligible states according to a formula that directs more funding to states with larger uninsured populations, with $8,151,185 earmarked for Texas. At least two types of eligible entities will receive awards in each state, including at least one community and consumer-focused nonprofit.

You can find the full grant announcement on www.grants.gov by searching for CFDA 93.750.

Applicants must have an Employer Identification Number/Taxpayer Identification Number (EIN/TIN) as well as a Dun and Bradstreet Data Universal Numbering System (DUNS) number, and must register for the System for Award Management (SAM) database in order to apply. Completing these steps can take up to four weeks. More information can be found at the grants.gov page, “Get Registered.”

U.S. HHS will host two technical assistance calls in upcoming weeks for organizations interested in applying:

First call: Thursday, April 11, 2013 from 3:30 to 5:00 p.m. EDT

Toll-free teleconference phone number: 877-267-1577; ID: 5119

Second call: Friday, April 19, 2013 from 3:30 to 5:00 p.m. EDT

Toll-free teleconference phone number: 877-267-1577; ID: 2917

U.S. HHS also released a rule last week that proposes the training, conflict of interest, and privacy/security standards that will apply to Navigators. Comments on the rule are due by 5 p.m. on May 6, 2013.

Written by: Stacey Pogue, Center for Public Policy Priorities

This Friday, Feb. 22, Texas Well and Healthy invites you to two learning events you can attend from anywhere in Texas. First, our campaign is hosting an important health care action call at noon all about 2013′s Health Care Advocacy Day, March 5. (Just two weeks away! Have you registered?) Then at 3 p.m., the Center for Public Policy Priorities will host a webinar for community organizations on “Navigators,” the community-based, in-person assistance-providers who, under the Affordable Care Act, will help people enroll in Medicaid, CHIP, and private health insurance through the Health Insurance Marketplace (also known as the exchange). More about these two events can be found below.

Webinar on Navigators for Community Organizations
Friday, February 22
3:00 - 4:00 p.m.
To register, click here