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%

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