Delaware Health Insurance Marketplace Project Update

Delaware Health Care Commission Meeting, August 7, 2013

www.pcghealth.com

Delaware Marketplace

Consumer Assistance Update

Leslie Tremberth (PCG)

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Marketplace Guide Program Ramp-up

• In July, the State finalized contracts with four organizations that will hire and deploy Marketplace Guides throughout Delaware

• The four organizations will collectively provide up to 68 FTE Guides to educate consumers about the Marketplace and facilitate enrollment in Qualified Health Plans

• Guides will assist all consumers in need of support to determine coverage options in the new healthcare landscape, including expanded Medicaid

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Marketplace Guides - Contract Awards

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Brandywine Women’s Health Associates - $1,444,642 About 20 Guides - Focused on Small business & Individuals in greater Wilmington area

  Christiana Care - $555,050 About 7 Guides - Christiana Care New Castle County locations

Delmarva Foundation - $1,742,513 About 24 Guides - Focused on Small businesses in all 3 counties and individuals in Kent and Sussex Counties

  Westside Family Healthcare - $1,345,413 About 17 Guides - Statewide coverage 

Total Contract: $5,087,358

Supports approximately 68 Marketplace Guides

 

Marketplace Guides

• The contracted organizations have begun hiring individual Marketplace Guides

• Prior to certification, Guides must complete State-designed training, pass an examination and complete State and Federal background checks

• Formal Guide outreach activities will begin late this month and continue throughout and after the close of the open enrollment period

• Outreach plans are being reviewed and the State will work with the organizations to ensure sufficient coverage statewide and to target populations

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Federal In-Person Assister Entities

• The Federal government has been issuing additional guidance on both the Navigator and Certified Application Counselor programs

• Navigator grant awards will be announced on August 15; at least two entities in DE are expected to receive funding

• Upon announcement of the Navigator organizations, the State will work quickly to engage with the selected entities and incorporate their outreach and enrollment activities with those of the Marketplace Assisters

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Certified Application Counselors

• Organizations interested in providing Certified Application Counselors must complete an application recently made available on CMS’ Health Insurance Marketplace website: http://marketplace.cms.gov/help-us/cac-apply.html

• Eligible organizations include community health centers or other health care providers, hospitals, and non-federal governmental or non-profit social service agencies

• CACs will help consumers to understand, apply for and enroll in coverage through the Marketplace but will not perform formal outreach activities

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Federal Marketplace Training

• All Federally-contracted assister entities must complete Federal training prior to conducting any activity related to the Marketplace

• The Federal government recently made its agent/broker training available and training for other assisters will be made available in late August

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Delaware Marketplace

Plan Management Update

Linda Nemes (DOI)

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QHP Review Update

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Next Up--Plan Preview Activities (mid August through early September 2013)

Plan Preview is essentially a ‘quality assurance’ process activity between the Issuers, CMS and the State•Conducted concurrently with CMS (federal) review of the state’s recommendations for QHP certification •Provides Issuers with an opportunity to ‘preview’ their plans as they would appear on the Federal Marketplace Portal to ensure that plan-related information displays correctly.

Issuers are permitted to correct any errors, and make minor changes only The Delaware Plan Management team will participate in the Plan Preview

period, providing information and context to assist CMS/CCIIO and the Issuers during the process

• CMS will complete its review and finalize the QHP Certification with Issuers in mid September.

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