Survey of Health Insurance Marketplace Assister Programs

In response to open ended questions, Assister Programs identified key resources that helped them be more effective in helping consumers.  For example, 40% of Program directors cited training provided by the Marketplaces – in particular, trainings provided throughout the Open Enrollment period as Marketplaces modified online applications to improve functionality, as well as more in depth training modules on key issues covered in initial training sessions.  Almost 40% of Assister Programs also said the Marketplace call center helped them to be more effective.  The ACA requires all Marketplaces to operate a toll-free call center, and Assister Programs relied on this resource when faced with technical online problems and to resolve more complex consumer problems (Appendix Table 10).

Assister Programs also identified a number of improvements they believe are important to help them assist consumers more effectively.

Assister Programs want more and more timely training. All Assister Program staff undergo initial training to be certified by Marketplaces.  Assisters in the FFM had to complete between 5 and 30 hours of training before they could begin helping consumers.  In some states, federally certified Assisters were required to complete additional state-required training, which could take up to 3-4 more weeks to complete, before they could begin work.  In order to be re-certified next year, Assister Programs recommend that revised training courses be available sufficiently ahead of the start of the next Open Enrollment.

The content of initial training varied depending on the Assister Program.  CAC training developed by the federal Marketplace was the most basic, covering information about the individual mandate, assistance available through the Marketplace, the application process, and rules about protecting clients’ personally identifiable information.  Federal training for Navigators was somewhat more detailed.  Regardless of their initial training, though, 92% of Assister Programs say they would like to receive additional, more in-depth training on specific topics.  Training on post-enrollment problems and tax-related issues top the list, followed by immigration-related issues and more training on QHP features and differences (Appendix Table 2).  In response to open ended questions, some Assister Programs also recommended training on the online application system itself (Appendix Table 10).

Assister Programs suggest strengthening Marketplace call centers.  Virtually all Programs relied heavily on their Marketplace call center to answer questions and resolve problems, though with mixed success.  Assister Programs gave Marketplace call centers lower marks for helpfulness (only 69% of Assister Programs rate Marketplace call centers as very or somewhat helpful).  In response to an open ended question about what Marketplaces should improve, half of Programs cited their call center.   Programs say it could be difficult to get through to call center operators, particularly during peak enrollment periods.  They also cited shortages in bilingual call center staff.  In addition, some complain that call center representatives didn’t always provide accurate or consistent information (Appendix Table 9 and 10).

Programs in Marketplaces that provided a dedicated call center line for Assisters reported this technical assistance was more effective.  Programs in Marketplaces without a dedicated Assister help line expressed the need for one. (Appendix Table 10)

Assister Programs acknowledged the value of coordination among Programs.   Assister Programs that coordinated efforts reported improved efficiency in a number of areas, though not all Programs coordinated.  Almost one-quarter of Assister Programs report they coordinate with other Programs often and on a regular basis.  Another 22% coordinated often but on an ad hoc basis, while 54% of programs report they never coordinated with other Programs or did so only infrequently (Figure 16).

Figure 16: Coordination Among Assister Programs

When Programs did coordinate with each other, most often they said coordination was initiated by Assisters themselves or facilitated by an outside entity other than the Marketplace.  Less than 20% of Programs said their Marketplace facilitated coordination among Assisters.  However, in SBM states, regular coordination among Assister Programs was more often initiated by the Marketplace (Figure 17).

Figure 17: Who Initiated Coordination of Assister Programs?

Overall, Programs that did coordinate said this was very or somewhat important to their effectiveness in planning outreach events and activities (80%), and in resolving consumers’ complex questions and problems (81%).

Most regularly-coordinating Programs also said it was important in scheduling appointments. In North Carolina, for example, Assister Programs operated a centralized scheduling system.  Residents of that state could call a single number and be referred to the nearest Assister Program with available appointments.   Programs that coordinated with each other could also share bilingual staff and contractors, and so found it easier to make interpreter services available to consumers (Appendix Table 3).  In response to open ended questions, several Programs from states that facilitated coordination also noted the importance of being able to offer real-time feedback to Marketplace officials.

Assister Programs that coordinated regularly with each other tended to engage in a wider range of activities, including outreach and public education, helping small employers, helping individuals with post-enrollment problems, and appeals of eligibility determinations.  Coordinating Assister Programs also were much more likely to report helping other Assister Programs (Appendix Table 4).

Other improvements were also suggested by Programs in response to open ended questions.  These include:

Web Site Reliability

Programs emphasized the need for better surge capacity to reduce web site slow-downs and repairs of other glitches.  They also recommended improvements to Marketplace web site functionality, including development of online chat systems to answer consumer questions, pop-up windows with more detailed instructions on how to complete the online application, better plan comparison tools, and translation of web sites into more languages.  Some Programs also urged that consumers not be required to submit an email address in order to apply online.

Assister portal to access the Marketplace enrollment system

In some states Assisters could log into the Marketplace web site through a secure portal, then help consumers complete online applications and track their status.  Programs with such access emphasized its usefulness to case management.  They could contact the Marketplace about pending verifications and eligibility determinations, and they could re-contact consumers to remind them of needed follow up.  Without a portal, case management could be more difficult.  For example, 30% of Assister Programs said they did not know the enrollment outcome for a majority of their clients.  If consumers delayed picking a plan to a later time, it could be impractical for Assisters to follow up to offer reminders and additional help.   Assister portals also facilitated data collection, helping both Marketplaces and Assister Programs, themselves, track performance patterns and the need for further training and technical assistance.

More Marketplace resources for Assisters

In response to an open ended question about suggested improvements, 12% of Programs recommended increasing Marketplace resources, including increased funding for Assister Programs.  Some Programs also urged that Marketplaces pay directly for more media advertising and sponsor more outreach and public education events.  In addition, some Programs want Marketplaces to make more consumer information resources available, such as handouts explaining ACA requirements and health insurance terms.  Some stressed the need for materials translated into other languages and urged that the accuracy of translation needs to be improved in some cases (Appendix Table 10).

Privacy and security standards

Most Programs were satisfied with Marketplace rules for safeguarding clients’ personally identifiable information (PII), but 40% said safeguards were so rigid as to interfere with Assisters’ ability to track client cases and provide follow up assistance (Appendix Table 5). Programs often developed workarounds – for example, all Marketplaces required Assisters to obtain signed consent to provide assistance, and some Programs designed consent forms to also include other key information, such as the client’s eligibility determination, needed follow up steps, and contact information.  Other Programs created worksheets for consumers to take with them that recorded account numbers, passwords, information about the plan selected, next-step instructions, and other key information consumers would need to keep and track on their own.

Other Assister Program best practices

In an open ended question about best practices, Programs also recommended strategies they followed to improve the assistance process.  For example, 10% of Programs described “pre-screening” procedures they used while making appointments to advise consumers on the kinds of information they might need during the application process. This helped the actual assistance appointment to proceed more smoothly.   Some Programs also designated staff to “pre-assist” consumers by helping them set up an email account in advance if they didn’t already have one.

Thirty-three percent of Programs also described partnerships with others in their community who could help with effective outreach or key resources such as meeting space or computer labs.  Programs also formed strategic partnerships with tax assisters, insurance brokers, and others offering specialized expertise.

In addition, Programs emphasized the importance of in-house coordination, including regular meetings to share information and seek peer advice.  Programs also adopted creative approaches to staff specialization, designating the most expert staff to consult on complex cases and mentor new hires, scheduling specialists to pre-screen clients and ensure availability of interpreter services or accessible assistance when needed, and training specialists assigned to monitor all Marketplace updates and trainings and ensure information was imparted to colleagues (Appendix Table 10).