Connecting Navigators to Jobs so They Can Continue Connecting Consumers to Coverage

Navigators are key to health care outreach and enrollment across the country, but in Cook County the number of working Navigators is on the decline as grant funding slows. This is not only bad for individual Navigators unable to find work, but compromises the success of future enrollment cycles. In-person assisters of all stripes — including Navigators, Certified Application Counselors, agents, and brokers — play a crucial role in helping people apply for coverage. An Enroll America study found that people who got in-person help were nearly 60 percent likelier to enroll. To help keep assisters in the community, through the Health Insurance Workforce Pipeline Initiative, Health & Disability Advocates and the Chicago Cook County Workforce Partnership are connecting unemployed Navigators with jobs in the health insurance field — specifically as brokers.

Health & Disability Advocates is leveraging its connections in the health insurance community to bring employees and employers to the table. Meanwhile the Chicago Cook Workforce Partnership contributes Workforce Investment Opportunity Act (WIOA) dollars that pay for job-readiness training, workshops, and on-the-job training that new hires may need once they start their jobs as brokers. Since its formation in early May 2015, the Health Insurance Workforce Pipeline Initiative has hosted Rapid Response Workshops that describe the resources available for unemployed or soon-to-be unemployed enrollment assisters. HDA and CCWP also organized an exclusive job fair where Navigators could meet and interview with employers looking to hire.

Former Navigators are already transitioning into new jobs thanks to this initiative. A group of eight new hires who had previously collaborated as enrollment assisters to connect 51,000 people with Medicaid and marketplace coverage will now be working together as brokers, drawing on their experiences as Navigators. According to Tearalla, a new hire, “As a broker, my Navigator skills are transferable and aligned with my current responsibilities. I will continue to provide outreach, education, and enrollment assistance to newly enrolled consumers and consumers seeking to re-enroll in the Marketplace.”

These transitioning Navigators will be doing outreach and drawing on their strong connections — including with Navigators — in the communities where they worked for the first two enrollment cycles where they already have strong connections. Said Tearalla, “Networking with existing community stakeholders is ongoing.”

Everyone wins — employers and Navigators alike — when these Navigators transition into new roles as brokers. According to one hiring manager, they were able to hire more former Navigators because money spent for training was covered by WIOA dollars. The hiring manager was also excited that the new hires have great working relationships with groups and community leaders.

New hires are eager to continue enrollment work. They are already reaching out to previous community contacts to spread the word about their new role and the ongoing opportunity to get health insurance. Said one former enrollment assister, Olivia, “I’m excited about the opportunity to continue to enroll folks in the ACA.” It’s a wonderful opportunity for the overall enrollment push in Illinois, too. Having seasoned pros with strong community connections on the front lines of Affordable Care Act outreach like Olivia and Tearalla can help set up a strong foundation for the upcoming enrollment cycle and get even more people connected to health insurance.

This post originally appeared on Enroll America's blog.

Bryce Marable
Health Policy Analyst
Health & Disability Advocates

Read More

UnitedHealth Group Losing Big Money and Threatening to Leave the Obamacare Exchanges--Because the Obamacare Insurance Business Model Does Not Work

It's official. The Obamacare insurance company business model does not work.

UnitedHealth Group just announced they expect to lose $700 million in the Obamacare
exchanges and are seriously considering withdrawing from the program in
the coming year.

This morning, the Wall Street Journal reported just about everybody else is losing their shirts in Obamacare as well:

Several other big publicly

Read More

An Observation on the “Observation Status” Law: It Doesn’t Work

The law, called the NOTICE Act, requires hospitals to notify patients hospitalized for more than 24 hours if they are on observation status. The law won’t go into effect until next August, which is great, because it could be better.

The way the law is written right now, it’s almost like asking a patient under anesthesia to sign a consent form. Within the first 24 hours of being admitted to the hospital for a medical event, many people—especially older people—aren’t able to focus on complicated issues of their status and its consequences.

Being on observation status has significant financial consequences. Observation status is considered outpatient service by Medicare. All care, supplies and procedures are covered under Part B, not Part A, and therefore are subject to Part B's higher deductible and co-pays. On top of that, most hospital pharmacies do not contract for Part D drug payments. Patients who have to take their normal medicines while under observation status will have to submit reimbursement requests to Medicare.

If a patient requires skilled nursing care after being discharged, Medicare will only pay for it following three days of inpatient hospitalization. Being on observation status—an outpatient—doesn't count toward the three-day requirement.

One Woman’s $3,900 Surprise

Jean Arnau, an 84-year-old who spent five days in the hospital with a fractured spine is a perfect example of how observation status poses consequences after discharge. She was in a hospital bed, wore a hospital gown and ID bracelet, ate hospital food and received regular nursing care.

When she was discharged and needed to transfer to a skilled nursing facility for rehabilitation, her family learned that she had never been formally admitted as an inpatient to the hospital at all. Instead, she'd been classified as an outpatient under observation and the nursing facility would charge almost $4000.

What To Do Until There’s a Real Fix

It’s great that the NOTICE Act requires patients receive “accurate, real-time information with respect to their classification, the services and benefits available to them, and the respective cost-sharing requirements they are subject to." It’s just that doing it within 24 hours of admission is too often not fair.

Talk to your clients, and their loved ones, before the need arises. The Center for Medicare Advocacy has put together a thorough packet explaining what your clients can do to protect themselves.

You can help by discussing these things with them:

• Urge them to ask about their status each day they are in the hospital. It can change from day to day.
• Tell them to ask the hospital doctor to reconsider your case or refer it to the hospital committee that decides status.
• Tell them to ask their primary care physician to state whether observation status is justified. If not, ask him or her to call the hospital to explain the medical reasons why you should be admitted as an inpatient.
• If they need rehab or other continuing care but learn that Medicare won't cover a a skilled nursing facility, tell them to ask their doctor if they qualify for similar care at home through Medicare's home health care benefit, or for Medicare-covered care in a rehabilitation hospital.
• After the fact, let them know they can appeal a Medicare decision of non-coverage. All the avenues for appeal are spelled out in the Center for Medicare Advocacy’s packet.

Preparing loved-ones before they are hospitalized isn't a fix to law, but it will empower future patients with a plan and knowledge of their rights. After having these conversations, patients will be more enabled to fight for their rights while Washington hopefully gets around to making much needed improvements to the law.

Phillip Lanier
Health Policy Intern
Health & Disability Advocates

Read More

Halloween Marks a Scary Time for Health Care in Illinois

If things don’t change soon, health care could be in for major setbacks in Illinois. The State budget battle is approaching its fifth month and counting.  So far, Medicaid payments continue per court order, but other services are beginning to run out of money:

• State payments to 911 call centers throughout the Illinois have been suspended, putting emergency services in jeopardy. 
• Illinois has stopped paying medical and dental claims for 150,000 state employees. The long-term cost of delayed care for a group of this size could be far greater than the cost of paying for care and preventative care today. 
• The state’s Psychiatric Leadership Capacity Grant, which was $27 million in the State’s FY2015 budget, is no longer being funded, affecting most of the 140 community health centers in Illinois and thousands of people who rely on them for psychiatric care. 

The longer the State budget impasse continues, the more services will be cut. These include services that indirectly have an impact on Illinois health care, such as after-school programs to keep kids out of trouble and supplemental nutrition programs, especially for the older adults.

It’s Not Too Late to Raise Your Voice!  

Contact your State legislators to let them know how concerned you are about the future of health care in Illinois. Tell them that Illinois seniors and children are especially vulnerable. We can’t let cuts affect them.Many program cuts will result in greater costs to the State in the not-so-long run. For example:

• Home care services and home delivered meals to seniors citizens cost a fraction of the $75,000 annual cost of nursing home care. Cuts to these programs will mean more seniors ending up in nursing homes, paid for by Medicaid. 
• Cut backs to after-school programs and Department of Children and Family Services support for older children will mean more kids and young adults intersecting with the justice system. Even short-term incarceration can pay for a full year of after-school activities for a child.
• Cut backs to mental health services will only cause an increase in city and country jail populations where the State will not only have to provide mental health services, but food, clothing and shelter. 

And remind them that, as the State’s infrastructure crumbles and the State’s bond ratings tumble, it will only get more and more expensive to catch up.

Phillip Lanier
Health Policy Intern
Health & Disability Advocates

Read More

Crocodile Tears Over the Failing Obamacare Co-Ops--The Canaries in the Obamacare Coal Mine

I can't believe what I've been hearing recently from Obamacare
defenders over the failing Obamacare co-ops--the most recent count has
eight of them going bust.

The biggest complaint seems to be that
those mean Republicans forced these co-ops out of business because of a
provision they included in the last budget.
Read my post at Forbes

Read More

Flat Enrollment Estimates For 2016--Has the Obama Administration Given Up on Obamacare?

On Thursday, the Obama administration said they expect to have 10 million people enrolled on the Obamacare
insurance exchanges in 2016. They further said they expect to sign-up
only one in four of those still uninsured and eligible during the 2016
open enrollment scheduled to begin on November 1.

These are astonishing admissions.

In
2013 the Congressional Budget Office (CBO) estimated that

Read More

Ohio Governor John Kasich's Medicaid Expansion: Successful Governance is Very Hard Work

Presidential candidate John Kasich (R-Ohio) has taken a lot
of criticism on the campaign trail for expanding Medicaid under
Obamacare. But if his Medicaid expansion isn’t an extraordinary example
of successful conservative governance I don’t know what would be.

See My Post at Forbes

Read More