Leveraging ACA Funding Opportunities

The Affordable Care Act includes a variety of grant opportunities that states can pursue to support their implementation efforts. While the latest hot topic has been the exchange establishment grants, the ACA also provides grants to support state rate review efforts, health care workforce training, the development of eligibility and enrollment systems, and public health and health education initiatives. As SHAP states enter the final year of their programs, it is important to think about these grant opportunities as potential vehicles for sustaining initiatives that were developed over the last two years.

Many states are thinking strategically about how to approach pursuing ACA grant opportunities, as evidenced by the tracking mechanisms they have developed. Several states have shared their ACA grant opportunity tracking documents on State Refor(u)m, which contains a milestone for pursuing ACA grant opportunities. These tracking sheets provide states with the ability to track what funding opportunities there are available to take advantage of, assign which state entity should be responsible for pursuing the opportunity, and provide an overview of key deadlines. Here’s a quick overview of what states have shared:

• Nevada’s tracking sheet includes the award amounts for grants that the state has received thus far. The sheet also includes an overview of what grants are to be expected in the future and links to organizations that monitor funding opportunities.
• Alaska, New Mexico and Ohio created spreadsheets to track the various grants that their states are pursuing. These spreadsheets include valuable information that the states are using to manage the process, including: award amounts, cost sharing information, and potential partner agencies.
• Vermont’s tracking spreadsheet not only includes a list of available grants and key deadlines, but also includes periodic status updates for grants that were awarded to the state.
• West Virginia created a website to manage the administration of its grants. The website includes a list of grant awards and indicates which state agency is responsible for managing each grant. The site also includes a grants forecast, which lists potential grant opportunities in the future.

In addition to the work that states are already doing on pursuing ACA grant opportunities, NASHP has been working to prepare resources for SHAP states to support their sustainability efforts. Last month, the NASHP SHAP team prepared a crosswalk to potential federal funding opportunities for the Colorado team. This crosswalk analyzes the state’s current SHAP efforts and identifies several federal funding opportunities that could potentially align to support their program’s goals. You can download the crosswalk for Colorado here, and we encourage other SHAP states to contact the NASHP team for similar technical assistance.

How to Succeed in Business (With Health Insurance Buying): Formulating a Health Insurance Outreach Strategy to Engage Small Businesses

Much attention has been paid lately to the role of small businesses in advancing health insurance coverage, right down to last Tuesday’s choice to release the new Health Insurance Exchange Regulation at a local DC hardware store.  Such small businesses employ over 42 million Americans, yet because of their small scale and the escalating costs of health insurance coverage, many struggle to purchase or maintain coverage for their employees.  As a result, nearly 23 million small business owners, employees, and dependents are uninsured.

New opportunities offered by the ACA, including the Small Business Health Care Tax Credit, better position these employers to offer coverage.  States must strategize about how they may wish to engage small businesses in the health insurance market to take advantage of these opportunities.  To glean some important outreach lessons for states, I recently spoke with Terry Gardiner, Vice President of Policy and Strategy, and Jessica Stone, Outreach Manager, of the Small Business Majority, who shared the following valuable lessons:

1)      Small businesses are not your typical consumer

Small business owners are busy individuals whose primary interest is to ensure that their businesses stay afloat.  Messages tailored to small businesses need to be clear, concise, and should focus on how health insurance might improve a business’s bottom line.  Outreach workers should prepare an elevator speech that can quickly engage employers by mentioning such positive benefits like the Health Care Tax Credit.  These workers should also be prepared to offer support options for employers who lack administrative personnel to assist in the procurement and administration of health insurance.

2)      There is not one “silver bullet” approach to reaching small businesses

The U.S.’s 5.8 million small businesses range greatly in everything from industry (agriculture, retail, construction, etc) to location (rural, urban, suburban).  Owners may spend most of their time at a desk, out in the field, or even working out of their car, while employees may be full-time, part-time, seasonal or salaried.  States should closely examine their small employer industries and develop multiple outreach strategies that account for this variability through creativity and targeted messaging.

3)      Network! Network! Network!

Only about half of small businesses belong to a formal business group such as a chamber of commerce.  So in addition to reaching out to those groups, states should look for local networks like community groups (e.g. Kiwanis Club) and trade associations (e.g. local alliance of realtors) through which outreach can be presented on a business owner’s “home turf.”  States may also research licensing databases for lists of licensed businesses by size and region.  Outreach efforts will work best when they strive to engage small business owners through a clear presentation of facts on access to health care and insurance opportunities relevant to the local community.

4)      Promote small businesses as “catalysts for change”

Increased participation and pooling of small employers in the health insurance market, especially with the development of the Small Business Health Options Program (SHOP Exchanges), will likely increase their influence over market behavior and practices.  States can work with small businesses to capitalize on this influence and promote innovative insurance design including health co-ops, integrated health plans, and plans with wellness programs.  This increased empowerment can also be leveraged as a selling point in messaging to small businesses, especially for those that have previously been reluctant to buy health insurance coverage.

Examples of approaches and materials developed with such valuable lessons in mind are available from several SHAP states including Maine, New York, Texas, and Washington, which have all strategized on ways to educate small employers about health insurance coverage opportunities. Many thanks to Mr. Gardiner and Ms. Stone for sharing their insights on this topic.  As always, if you would like any additional technical assistance on this or any other topic, please feel free to contact our SHAP team: Anne Gauthier, Kathy Witgert, Denise Osborn, Chris Cantrell, or Christina Miller.

Drinking from a Fire Hose: Streamlining Eligibility/Enrollment and Preparing for the ACA

The Affordable Care Act is estimated to expand coverage to 32 million people.  The task of enrolling these newly eligible individuals is primarily the responsibility of the states. Although states have had plenty of experience with enrollment in the past, the recent experience with enrolling people into coverage through the State Health Access Program (SHAP) provides some fresh insight for states as they prepare to enroll large numbers of newly eligible individuals.

Over the past six months, the NASHP SHAP team conducted site visits to several of the SHAP states in conjunction with Maximizing Enrollment, a Robert Wood Johnson Foundation program that aims to support states in building more efficient and effective eligibility and enrollment systems for public and publicly subsidized coverage programs. This collaboration produced several findings on how SHAP states are seeking to improve eligibility and enrollment processes. These findings may be useful to states as they prepare to react to a flood of new enrollees. Here are some examples of ways states are working to make it easier for people to enroll into coverage:

Online Eligibility and Enrollment:

• One way that states are making enrollment easier is through developing online applications.  This reduces the costs and potential errors associated with mail-in applications. Furthermore states that use online applications are better able to electronically verify applicant information. Virginia and Wisconsin have implemented online applications, which have allowed the two states to streamline their processes. In addition, New York has developed a new online screening tool that potential applicants can use to see what benefits they may be eligible for.

Outreach and Education:

• Since many new enrollees may have little or no prior knowledge about health insurance, some states are looking at ways to reach out to and educate their target populations about programs. Doing so can help these populations better navigate the health care system and access the services they need. Colorado is currently supporting community outreach through the Maximizing Outreach, Retention and Enrollment (MORE) mini-grant program. Through this program, the state is reaching out to a variety of populations to enroll them into their Medicaid and Child Health Plan Plus (CHP+) program.

In addition to streamlining eligibility and enrollment to make the process easier for consumers, states are also streamlining internal processes to prepare their infrastructure for an influx of new applicants.

Administrative Authority:

• One of the issues that states grapple with is coordinating enrollment systems. New York is in the process of transitioning administrative authority from its county-based enrollment system to a statewide enrollment center in phases, beginning with coverage re-determination. The state hopes that the new center will streamline renewals and help ensure that people maintain coverage as they transition between programs. With many states preparing to establish an exchange, centralizing enrollment and eligibility processes may also ease the transition and strengthen the capabilities of the exchange. However, states must ensure clients can still get the local assistance they need if states decide to move from county-based enrollment to a statewide system. Re-envisioning the county worker role to provide a different type of assistance may be a useful way to bolster a centralized statewide eligibility and enrollment system.

Self-Assessment and Eligibility Worker Insight:

• The Maximizing Enrollment program has developed a self-assessment tool to help state agencies identify opportunities for improvement in their eligibility, enrollment and retention processes.  The four-module tool provides a comprehensive assessment of state processes. As part of their MaxEnroll project, the Virginia Department of Medical Assistance Services commissioned a study that surveyed frontline eligibility workers and supervisors about their challenges with enrollment and provided them with an opportunity to share their ideas for process improvement. One lesson that came out of the study was that workers are juggling so many tasks that it would be helpful to have supervisors create checklists that outline priorities. This kind of opportunity for feedback can help departments find efficiencies in their processes.