Survey of Health Insurance Marketplace Assister Programs
|
Table A1. Eligibility Determinations Observed by Assister Programs |
|||||
|
Proportion of clients with eligibility determination |
Eligible for qualified health plan (QHP) and premium tax credit (PTC) |
Eligible for QHP, income too high to qualify for PTC |
Eligible for Medicaid or CHIP |
Income too high for Medicaid and too low for PTC (“coverage gap”) |
Income too high for Medicaid and too low for PTC (“coverage gap”) |
| Few or none | 10% | 65% | 16% | 41% | 41% |
| Some, but less than half | 40% | 26% | 33% | 36% | 36% |
| Most | 38% | 3% | 38% | 12% | 12% |
| All or nearly all | 8% | 0% | 6% | 1% | 1% |
| DK/NA | 5% | 5% | 6% | 10% | 10% |
| Table A2. Topics on which Assister Programs Would Like Additional Training | |
| Topic | % Programs |
| Assisting people with post-enrollment questions about their health plan | 41% |
| Tax filing issues | 41% |
| Immigration-related eligibility | 39% |
| Qualified health plan features and how to distinguish differences between plan options | 39% |
| Appeals | 36% |
| Medicaid and Children’s Health Insurance Program (CHIP) eligibility | 35% |
| Medicare-related issues | 34% |
| Low health insurance literacy | 34% |
| Exemptions | 33% |
| Eligibility for premium tax credits and cost sharing reductions | 32% |
| Special enrollment periods | 27% |
| Using the on-line application system | 26% |
| Availability of employer sponsored coverage | 25% |
| Assisting people who need translation services | 12% |
| Providing culturally competent assistance | 11% |
| Using the paper application | 11% |
| Accessibility for people with disabilities | 8% |
| Privacy and security | 6% |
| There are no additional topics or issues for which we would like additional training | 8% |
| Other | 7% |
| Table A3. Importance of Coordination to Effectiveness of Assistance Activities | ||||||
| Importance of Coordination | Planning Outreach Events | Developing Consumer Information Material | Scheduling Appointments for Enrollment Assistance | Resolve complex questions and problems | Assure availability of translation services | Assure accessible services for people with disabilities |
| Very important | 50% | 38% | 29% | 50% | 25% | 25% |
| Somewhat important | 30% | 32% | 23% | 31% | 22% | 22% |
| Not very important | 10% | 16% | 22% | 8% | 20% | 20% |
| Not at all important | 5% | 9% | 22% | 8% | 24% | 25% |
| DK/NA | 4% | 5% | 4% | 3% | 8% | 8% |
| Table A4. Percentage of Programs Conducting Assistance Activities | ||||
| Activity | Programs that Never Coordinated | Programs that Coordinated a Few Times | Programs that Coordinated Numerous times on Ad Hoc Basis | Programs that Coordinated Numerous Times on Regular Basis |
| Outreach to individuals and families | 50% | 81%a | 91%ab | 94%abc |
| Help with post-enrollment problems | 67% | 74% | 78% | 86%ab |
| Help with appeals of eligibility determinations | 45% | 53% | 65%ab | 71%ab |
| Help other Assister Programs | 20% | 40%a | 63%ab | 66%abc |
| Outreach to small businesses | 11% | 30%a | 34%a | 41%ab |
| a indicates a statistically significant difference from “Never”, p<.05 b indicates a statistically significant difference from “A few times”, p<.05 c indicates a statistically significant difference from “Numerous, ad hoc”, p<.05 |
||||
| Table A5. How Assister Programs View Balance of Privacy Rules and Ability to Conduct Assistance | |
| Level of Balance | % Programs |
| The balance was about right | 58% |
| The balance tipped too much in favor of privacy and security, limiting ability to track clients and provide follow up assistance | 40% |
| The balance tipped too much in favor of Assister access to PII, reducing privacy and security of client information | 2% |
| Table A6. Likelihood Assister Programs Will Continue for 2014-2015 Open Enrollment | ||||
| Likelihood | All Programs | CAC | FQHC | IPA, Navigator, FEAP |
| Very likely | 76% | 71% | 88%ac | 72% |
| Somewhat likely | 8% | 10%b | 5% | 8% |
| Somewhat unlikely | 2% | 3% | 0% | 2% |
| Very unlikely | 3% | 2% | 1% | 5%b |
| Not sure | 11% | 14% | 5% | 12% |
| a indicates a statistically significant difference from CAC, p<.05 c indicates a statistically significant difference from IPA, Navigator, FEAP, p<.05 |
||||
| Table A7. Number of Assister Programs that Expect Staff to Continue Working During 2014-2015 Open Enrollment | |
| Assister Staff Who Will Continue | % Programs |
| Almost all will continue | 65% |
| Most will continue, some will not | 20% |
| Some will continue, most will not | 7% |
| Almost none will continue | 1% |
| DK/NA | 7% |
| Table A8. Reasons Consumers Sought Help and Problems Assister Programs Found Most Difficult to Help With | ||
| Reason | % Programs who say most/nearly all clients sought help for this reason | % Programs who say this reason was the most difficult to help with |
| Limited understanding of ACA | 87% | 27% |
| Help understanding/evaluating plan choices | 83% | 37% |
| Lack of confidence to apply on one’s own | 80% | — |
| Online technical difficulties | 65% | 55% |
| Problems persisting after contacting call center | 49% | — |
| Questions relating to household income | 49% | 13% |
| Medicaid eligibility questions | 49% | 16% |
| Questions relating to defining household members | 44% | 8% |
| Lack of internet access at home | 41% | 17% |
| Tax-related question | 26% | 14% |
| Need translation assistance | 18% | 13% |
| Question related to verifying immigration status | 10% | 22% |
| Help filing exemption | 10% | 7% |
| Questions related to ESI/COBRA | 8% | 17% |
| Other ID proofing question (not immigration related) | 7% | 19% |
| Help with disability | 5% | 3% |
| Table A9. Sources and Usefulness of Technical Assistance for Assister Programs | |||||
| Technical Assistance Offered by Marketplace | Outside Sources of Technical Assistance | ||||
| Resource | % Programs Using Resource | % Rating Very or Somewhat Helpful* | Resource | % Programs Using Resource | % Rating Very or Somewhat Helpful* |
| Online resources, tips, updates for Assisters | 57% | 90% | State primary care association | 15% | 94% |
| Newsletter for Assisters | 51% | 88% | Other Assister Programs | 27% | 93% |
| Webinars for Assisters | 66% | 87% | HRSA | 15% | 93% |
| Periodic networking meetings with other Assisters | 31% | 84% | Technical Assistance offered by other private entities | 9% | 92% |
| Regular calls with Marketplace staff | 37% | 82% | Brokers and agents | 13% | 92% |
| Ad hoc calls with Marketplace staff | 19% | 82% | State insurance department | 11% | 90% |
| Help line dedicated for Assisters | 43% | 77% | Tax preparation organizations | 6% | 81% |
| State Marketplace call center | 46% | 69% | Health insurance company help lines | 18% | 79% |
| Federal Marketplace Call Center | 50% | 69% | State Medicaid agency | 36% | 73% |
| * percentage based on respondents who used the resource | |||||
| Table A10. Assister Program Responses to Open Ended Questions about What Worked Well and What Changes Would Help them be More Effective | |
| Feature or Resource | Percent of Assister Programs |
| Briefly describe up to 3 things the Marketplace did that helped make the work of your Assister Program more effective | |
| Training (net) | 40% |
| Updated training/webinars | 25% |
| Initial training | 9% |
| Call Center (net) | 39% |
| Call center was helpful, generally | 25% |
| Dedicated line for Assister Programs | 12% |
| Assister Resources (net) | 18% |
| Consumer materials by Marketplace | 10% |
| Online resources for Assisters | 6% |
| Funding for Assisters | 2% |
| Marketplace Website | 16% |
| Online application | 8% |
| Live “chat” feature | 2% |
| QHP “window shopping” feature | 2% |
| Coordinating Assisters (net) | 14% |
| Regular calls to share information | 10% |
| Formal networking of Assister Programs | 3% |
| Marketplace staff responsiveness | 5% |
| Outreach by Marketplace (net) | 5% |
| NA | 11% |
| Briefly describe up to 3 things the Marketplace might change to help make the work of your Assister Program more effective | |
| Call Center (net) | 48% |
| Strengthen staff training | 25% |
| Provide dedicated line for Assisters | 16% |
| More call center staff | 12% |
| Website (net) | 42% |
| Fix website glitches | 22% |
| Create portal for Assister online access | 11% |
| Create live “chat” functionality | 5% |
| Training (net) | 27% |
| Make available for initial certification, updates | 14% |
| More in-depth training on specific topics | 7% |
| Training version of online application | 6% |
| Assister Resources (net) | 12% |
| More funding for Assister Programs | 6% |
| More printed resources for consumers | 5% |
| Increase number of Assister Programs | 2% |
| Policy Changes (net) | 8% |
| Improve Marketplace staff responsiveness | 2% |
| Conduct appeals of eligibility denials | 1% |
| Clearer consumer notices | 1% |
| Improve Coordination with Medicaid | 7% |
| Increase Outreach by Marketplace | 6% |
| Coordinate Assister Programs | 5% |
| NA | 6% |
| Briefly describe up to 3 practices of your Assister Program that you would recommend as best practices to others | |
| Model Work Practices | 50% |
| Scheduling strategies | 20% |
| Pre-screen clients to prepare for their appointment | 10% |
| Professional standards | 10% |
| Periodic meetings to coordinate Program staff | 6% |
| Hiring practices | 6% |
| Specialization of Assister staff | 4% |
| Strategic Partnerships | 33% |
| Community partners for outreach | 26% |
| Community partners for expertise | 6% |
| Counseling Skills | 11% |
| Training | 11% |
| Develop Helpful Forms/Worksheets | 10% |
| Casework Strategies | 7% |
| NA | 13% |