Get Covered Tennessee

A private collaboration to help uninsured Tennesseans understand and enroll in new health care coverage options provided by the Patient Protection and Affordable Care Act

 In Tennessee, more than 900,000 children and adults are currently uninsured.  This means that nearly one in six Tennesseans lives without access to timely, appropriate, and affordable medical care.  The federal health care law, the Patient Protection and Affordable Care Act, will provide new public and private health insurance options to all of these uninsured individuals and families [1], and nearly 95% (more than 870,000 adults and children) will also qualify for financial assistance to help them afford coverage.  However, national research has demonstrated that 78% of newly-eligible individuals are unaware of their new options and when informed, 75% of consumers say that they will need help to enroll.

Studies show that compared to people without insurance, those with coverage are more likely to have access to medical treatment, utilize appropriate levels of care, and report being in better health.  Beyond the benefits to the individuals in need, the entire health insurance market will depend on robust efforts to enroll large numbers of healthy individuals in order to balance the risk pool which, in 2014, will include people that were previously denied policies due to pre-existing medical conditions.  Furthermore, health care delivery system reforms depend on the premise that more people will get enrolled in health coverage in order to reduce uncompensated care costs and give providers more sustainable funding for improvements and efficiencies that will result in lower health care costs system-wide.   

                We are facing an extraordinary challenge and a once-in-a-lifetime opportunity.

On October 1, 2013, open enrollment begins for the health insurance exchange - the online competitive marketplace through which individuals, families, and small businesses will shop for private insurance plans, compare their options, and purchase coverage to meet their needs.  Beyond its function as a “Travelocity for private health insurance,” the marketplace will also determine eligibility for TennCare, CoverKids, premium tax credits, and cost-sharing subsidies based on income level and family size.  The exchange website will be designed to function as a one-stop shop for health insurance and will certainly simplify the enrollment process, but it will not solve the problems we face to maximize enrollment.

Many of the individuals and families newly-eligible for affordable coverage will have had little experience with health coverage and a sizeable number will have low health literacy, limited English proficiency, or other limitations that will make it difficult for them to make informed health plan choices, not to mention the internet access or computer skills that will be necessary to shop the web portal itself.

On December 10, 2012, Governor Haslam announced his decision not to pursue a state administered health insurance exchange in Tennessee and our state defaulted to a federally-administered exchange, or marketplace.  Effectively, this means that the federal marketplace will be responsible for education, outreach, and enrollment assistance in our state.  With the understanding that they do not know our networks or community capacities, federal officials in D.C. will be looking for state-based partners to conduct these activities, and they are willing to allocate grants in order to fund the work. 

In an effort to fill the obvious need for a coordinated approach to address the challenge we are facing and with the understanding that our state administration is no longer responsible for coordination, the private sector has stepped up.  The Baptist Healing Trust, a private grant-making foundation based in Nashville, was working with the Haslam administration to develop a public-private partnership for this effort, and since the governor’s decision, has transitioned to a leadership role to coordinate the project as a private initiative.

Since November 2012, Baptist Healing Trust has worked to convene stakeholders, facilitate strategic planning, and provide technical assistance and coordination support for other organizations and collaborations that will apply for the federal funding available to Tennessee.  The Trust has employed Beth Uselton to research best practices, develop business plans, track policy developments, provide analysis, engage stakeholders, educate potential community partners, and recruit an impartial Advisory Council to provide guidance, advice, and leadership for this project. 

The Get Covered Tennessee council will offer collective knowledge, skills, and expertise in several areas as well as function to represent the interests of a broad spectrum of stakeholders.  Ultimately, the responsibility of the Council is to act as an impartial steering committee to inform and guide the project planning to promote collaboration among the stakeholders, provide expert advice to project partners, and make recommendations for operational considerations, marketing, and outreach strategies.

The Affordable Care Act requires exchanges to provide grant funding to Navigators, which are defined in the law as individuals or entities that assume these responsibilities:

  • Conduct community outreach and public education to raise awareness about the marketplace
  • Provide impartial, accurate information about new coverage options, including public programs like TennCare or CoverKids, as well as financial assistance for private insurance in the form of premium tax credits and cost-sharing subsidies
  • Provide direct assistance to individuals, families, and small businesses to help facilitate application and enrollment in the plan of their choice.
  • Provide culturally-competent assistance and linguistically-appropriate information
  • Demonstrate an ability to facilitate meaningful access for individuals with limited English proficiency and people with disabilities

These Navigator grants will be made available to Tennessee through the federal marketplace, which released a Funding Opportunity Announcement in April.  Navigator grants will be made to at least two entities in Tennessee and at least one must be a consumer-focused community-based nonprofit organization.  Navigator grants can be made to a single organization or collaborations, but preference will be given to organizations that demonstrate that they can work in successful partnerships. 

Get Covered Tennessee is working to recruit non-profit organizations that are positioned to provide Navigation services in their local communities and help connect them to larger non-profits that are able to apply for the federal grants.  These lead agencies will subcontract funding to community partners who have already developed trusted relationships with uninsured individuals and families in their service area and can demonstrate an ability to provide assistance services required of Navigators.

For additional information about Navigators, please visit the Enroll Tennessee website.

 


[1]

If Governor Haslam chooses to expand Medicaid in our state, using the federal funding made available by the ACA, TennCare will provide insurance to individuals and families below 138% of the federal poverty level.  If not, approximately 400,000 uninsured individuals under 100% of the poverty level will remain uninsured unless they fall into one of TennCare’s current categories of coverage.

 

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