Consumer Assistance Program Grants: Helping States Give Consumers Greater Control of their Health Care

Currently, individuals must often fend for themselves when trying to find affordable health insurance or to resolve problems with existing coverage.  These new Consumer Assistance Program grants will help make sure that consumers receive their new rights and benefits under the Affordable Care Act by providing nearly $30 million in new resources to help States and Territories.  These new grants will allow States, who are in some cases partnering with local non-profits, to help strengthen and enhance ongoing efforts in the States and local communities to protect consumers from some of the worst insurance industry practices.

These grants build on other programs and initiatives recently announced by the U.S. Department of Health and Human Services, such as the Patient’s Bill of Rights and www.HealthCare.gov, which gives consumers have new access to information about their health insurance options through tools like the Insurance Finder.  The grants will be used to educate consumers about their health coverage options and new programs, empower consumers to avail themselves of new protections, ensure consumers have access to accurate information, and help consumers navigate the system to find the most affordable and secure coverage that meets their needs. 

Using the grants, States and Territories will:

• Help consumers enroll in health coverage;
• Help consumers file complaints and appeals against health plans;
• Educate consumers about their rights and empower them to take action; and
• Track consumer complaints to help identify problems and strengthen enforcement.

A summary of how each State or Territory will use the new resources can be found at http://www.healthcare.gov/news/factsheets/2010/10/capgrants_states.html.

Consumer Assistance Programs will benefit millions of Americans by providing them with information on insurance options and their rights under the new law.  For example, if an individual loses coverage through his employer, and he needs to find new coverage for him and his family, a Consumer Assistance Program can help determine his needs, identify options available from private and public insurers, and help him and his family enroll in a new plan or policy.

Additionally, these grants will fund programs that will support consumers both now as we transition to a more competitive, patient-centered health insurance marketplace in 2014 and once that new marketplace is established.  These programs will help empower consumers and serve as their advocates, especially with regard to filing and resolving complaints and appeals.

Some states already provide this type of assistance.  Last year, one State recovered more than $1.4 million dollars for aggrieved consumers and another State put $20 million back into the pockets of healthcare consumers. In addition, one State’s mediation efforts resulted in 69% of medical necessity denials being overturned or modified by the carrier and more than $1.4 million in claims payments.  Thanks to this new grant program, these types of consumer assistance activities will expand significantly to benefit millions of additional Americans.

Posted: October 19, 2010