HLC Policy Committee April 6 2011 Stan Dorn Senior Fellow The Urban Institute Washington DC 2022615561 sdornurbanorg Topics Enrollment not necessarily a slam dunk Some examples of success ID: 266130
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Enrollment under the ACA: examples and best practices
HLC Policy Committee
April 6, 2011
Stan Dorn, Senior Fellow
The Urban Institute
Washington, DC
202.261.5561
sdorn@urban.orgSlide2
Topics
Enrollment: not necessarily a slam dunk
Some examples of success
Other best practices
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Enrollment: Not necessarily a slam dunk
Part I.
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Why enrollment matters
Access to care
Enforcement of the individual mandate
Stability of insurance markets
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CHIP and Food Stamps: Early history
Source: Selden, et al., 2004 (MEPS data).
Effective
10/1/97
Food stamps, after 2
years: 31% take-upSlide6
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More history
Medicare Savings Programs (MSP) reach < 33 percent of eligibles
In 2002, Social Security outreach to 16.4 million eligible people led to 74,000 enrollees
After much effort, Food Stamps reached an all-time high participation rate of 67 percent in FY 2006
CHIP and Medicaid reached 82 percent of eligible children in 2008Slide7
Percentage of eligible children enrolled in Medicaid or CHIP, highest and lowest states: 2008
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Source: Kenney, et al., 2010.Slide8
It’s not just low-income people!
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Source:
Laibson
2005.Slide9
Examples of success
Part II.
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Medicare Part D Low-Income Subsidies (LIS)
Total enrollment: 74%
Source: CMS enrollment data. Calculations by Urban Institute. Slide11
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Coverage expansion in Massachusetts
Extraordinary results
Only 2.6 percent of state residents were uninsured in 2008
Most new coverage was highly subsidized
Well-known policy changes
Subsidies up to 300% FPL, through Medicaid and the new “Commonwealth Care” (CommCare)
All adults mandated to purchase coverage
Health insurance exchange (the “Connector”) Slide12
Massachusetts: less well-known policies
Massive PR campaign
Public-private partnership
Consumer-friendly application process
One application form for multiple subsidy programs
“No wrong door”
Automatically qualified people for subsidies based on data
from prior free care pool
After 15 months, this accounted for roughly 1 in 4 newly insured
Application assistance
60% of all successful applications completed, not by consumers, but by application assisters
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Renewals in Louisiana
In many states, 30-50% of Medicaid/CHIP children lose coverage at renewal
Failure to complete and return the renewal form ends coverage, even if children continue to qualify
In LA, <5% lose coverage at renewal
When data matches show a reasonable certain of continued eligibility, automatic renewal
If more information needed, families encouraged to provide it by phone
<15% of families are asked to complete paperwork
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Some Best practices
Part III.
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How do we know?
Lots of work around child health
Many experts, including:
Center on Budget and Policy Priorities
Families USA
First Focus
Georgetown Center for Children and Families
National Academy for State Health Policy
State Coverage Initiatives program of AcademyHealth
The Children’s Partnership
Urban Institute
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Examples of best practices
Use authoritative data to qualify people for benefits
Simple applications in multiple languages
Diverse modalities for submitting applications
“No wrong door”
Consumer assistance
Streamlined renewals
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ACA implementation
New federal resources and guidance to support IT development
Early innovator grants
Examples: Wisconsin and Oklahoma
Other exciting innovation
Louisiana rides again
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Conclusion
High enrollment under ACA is possible
The legislation has many good elements
HHS is committed to effective implementation
But ACA is vast, and implementation duties will outstrip available resources, at both federal and state levels.
Nitty-gritty enrollment issues can easily fall through the cracks
Significant obstacles in many states
An outside coalition of stakeholder groups can keep the focus on enrollment best practices and make a significant difference, at the federal and state levels
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