Consumer Assistance Program Grants: How States Are Using New Resource to Give Consumers Greater Control of their Health Care

 American Samoa

Office of Health Insurance Consumer Assistance within the State Insurance Commissioner’s Office

Amount Awarded:  $120,000

• Establish an independent Health Insurance Consumer Assistance Office to meet the anticipated growing demand for services.
• Develop a state-of-the-art secure data system for health insurance information.
• Provide American Samoans with access to timely and comprehensive health insurance consumer assistance.

 Arkansas

Arkansas Insurance Department, Consumer Services Division

Amount Awarded:  $296,659

• Conduct statewide public education campaign and provide access to consumer protection specialists who will assist consumers to:
• Understand their rights and duties.
• Understand subsidies for which they might be eligible.
• Make informed choices for enrollment in appropriate health plans.
• Prepare and file claims, grievances, or appeals, including the navigation of an outside independent review process.
• Expand data collection, analyses, tracking and reporting processes that are already in place to identify marketplace problems so enforcement may be strengthened and data drive improvements achieved.
• Establish the Affordable Care Consumer Assistance Program, a separate unit within the Consumer Services Division, providing health insurance education which will process all health insurance inquiries and complaints
• Educate consumers, including small business owners and health care providers, about the health insurance exchange and consumer options, rights and duties afforded under ACA

 Connecticut

Office of the Healthcare Advocate

Amount Awarded:  $396,400

• Add three additional case managers, including a nurse consultant, an insurance examiner and a licensed clinical social worker, who will provide service expertise to staff a greater number of healthcare counseling/coaching sessions and appeals that OHA will provide and initiate on behalf of consumers.
• Hire one outreach coordinator/data analyst to the current staff who will:
• Conduct multiple formal and informal outreach sessions around the state to educate consumers about their healthcare rights under the Affordable Care Act and Connecticut law.
• Track referrals from outreaches and other sources, including new marketing materials to be developed with a portion of the grant allocation, analyze case data for trends and issue reports.

 California

Department of Managed Health Care, in partnership with the California Office of the Patient Advocate

Amount Awarded:  $3,400,000

• Develop and promote a coordinated consumer-friendly website and corresponding toll-free number that consumers can call with questions about health care coverage, and to receive assistance with the filing of complaints and appeals.
• Conduct a statewide media campaign, in partnership with consumer organizations, to educate consumers about their rights and responsibilities and to provide assistance with enrollment in group health plans or health insurance coverage.
• Evaluate the effectiveness of the initiatives, and collect, track and quantify consumer problems and inquiries for reporting to state and federal policymakers.

 District of Columbia

Department of Health Care Finance, Office of the Health Care Ombudsman and Bill of Rights

Amount Awarded:  $149,880

• Develop its technological infrastructure by purchasing call center functionality and encryption software.
• Contract for support for consumer education and outreach efforts.
• Enhance staff skills to improve case management through a rigorous training and case review process
• Provide additional training to staff to increase capacity and expertise.
• Establish a call center to be housed within the Department of Health Care Finance.

 Delaware

Office of Health Insurance Consumer Assistance

Amount Awarded:  $141,930

• Assist consumers with filing appeals (both internal and external) to health carriers for both insured and ERISA plans.
• Resolve claim disputes regarding fully insured health insurance policies.
• Help with open enrollment issues regarding group employer plans.
• Interpret fully insured health benefits or Summary Plan Descriptions.
• Help consumers covered by ERISA plans understand benefits and obtain answers and calling employers as necessary to obtain information.
• Conduct outreach sessions to the public and collect and compile reports regarding consumer concerns and possible trends found that will be shared with the federal and state regulators.

 Georgia

Department of Insurance

Amount Awarded:  $822,156

• Expand and enhance ability to provide assistance to consumers with health insurance issues, including ability to assist consumers wishing to formally appeal decisions made by their health insurer.
• Improve capability to receive and track telephone calls from consumers seeking assistance by implementing calls center functionality.
• Upgrade existing database systems to enhance the security of personally identifiable information and to obtain the ability to collect, track, and report data requested by Department of Health and Human Services.
  

 Guam

Department of Revenue and Taxation

Amount Awarded:  $149,880

• Handle appeals that could include assistance for filing both internal and external appeals on behalf of consumers
• Inform and assist Guam citizens and residents who qualify for enrollment with the Medicaid and CHIP programs.
  

 Illinois

Department of Insurance

Amount Awarded:  $1,454,594

• Conduct a comprehensive evaluation of existing Department consumer assistance activities.
• Establish a Consumer Advisory Council to monitor and provide independent review of the Department’s future consumer assistance activities.
• Develop a comprehensive and user-friendly Consumer Assistance Portal allowing easy online access to all services provided by the Department.
• Improve existing infrastructure used to conduct and track consumer assistance activities.
• Provide additional training and other resources to consumer assistance personnel.
• Hire staff to support the expanded consumer assistance activities.
• Develop and execute a targeted consumer outreach plan.
  

 Iowa

Iowa Insurance Division, Consumer Advocate Bureau

Amount Awarded:  $313,721

• Increase consumer assistance accessibility adding translation services for consumers.
• Increase consumer input into services by creating a Consumer Advocate Advisory Board that will meet on a regular basis.
• Promote health insurance rights and responsibilities through the media.
• Provide education through weekly website updates and public speaking events.
• Train consumer advocacy groups on the rights, responsibilities, and resources available to the public through health insurance updates.
• Work with consumers to aid in needed health insurance enrollment activities.
• Capture and report the service data to the Department of Health and Human Services.
  

 Kansas

Kansas Insurance Department

Amount Awarded:  $270,000

• Identify gaps in content, capabilities, and educational needs to support an expanded consumer assistance function.
• Provide a regimen of training and continuing education on the new rights and protections provided by the Affordable Care Act.
• Review and adopt best-practices involving external grievance review for consumers.
• Coordinate data collection and reporting system development with NAIC staff to ensure standardized reporting and timeline compliance with HHS regulations.
• Broaden outreach to a range of target groups using Internet, in-person events, education and traditional media- including consumers, small businesses, government agencies, insurance companies and other organizations.
• Increase staff and capacity.
  

 Kentucky

Department of Insurance, Consumer Protection Division

Amount Awarded:  $215,784

• Create new outreach opportunities to educate the citizens of Kentucky
• Expand the Department’s databases to include more detailed information on the types of issues consumers face in the health insurance market and with public insurance options.
• Serve as a resource to assist consumers with health insurance access issues and coverage denials.
• Develop new consumer-friendly printed materials and website tools, including appeal letter templates, educational brochures, various FAQs, and information regarding opportunities that provide access to insurance.
• Staff will be available to meet with individual consumers and be accessible to the public by phone and email.
• Assist consumers that have not initiated or completed their carrier’s internal appeal process as well as those needing help with the enrollment and application process.
• Hire 2 additional staff
• Guide consumers to the appropriate agency and attempt to determine if the consumer has received assistance from those agencies.
• Educate consumers about the public options available to them under Medicaid, KCHIP, the Pre-Existing Condition Insurance Plan and Kentucky Access.
• Enhance existing databases to allow staff to capture additional information about health insurance access, affordability, and coverage issues.
  

 Maine

Office of the Attorney General, in coordination with the Bureau of Insurance

Amount Awarded:  $135,000

• Assist consumers, both by phone and through walk-in service, with filing appeals and complaints.
• Provide information on the external appeals processes.
• Establish a hotline and hire a staff member to respond to incoming calls.
• Provide consumers with the resources to contact the Consumer Assistance Program.
• Educate consumers about their rights and responsibilities with respect to their group health plan or health insurance coverage, through an aggressive field campaign of community meetings.
• Assist consumers with enrollment in group health plans or in obtaining health insurance coverage by providing information and referrals to the most appropriate plans available to them.
• Provide one-on-one assistance to consumers to help consumers navigate and understand their insurance options.
• Expand current services to include a component that assists consumers in obtaining premium tax credits.
• Collect, track and quantify problems encountered and inquiries made by consumers.
  

 Maryland

Office of Attorney General, Consumer Protection Division, Health Education and Advocacy Unit (HEAU)

Amount Awarded: $599,220

• Hire additional staff to assist with additional consumers, including:
• Deputy Director to help manage the cases and HEAU staff.
• Two additional Health Ombudsman.
• Additional support staff member.
• Medical professional to assist the Ombudsmen in preparing appeals and grievances, especially in cases involving medical necessity.
• Outreach coordinator to educate consumer and providers about the HEAU.
• Provide more consumers with assistance with the appeals and grievance processes.
• Generate reports that are required under the grant program.

 Massachusetts

Massachusetts Executive Office of Health and Human Services

Amount Awarded:  $742,888

• Educate consumers about their rights and responsibilities via HCFA’s innovative, proven, and culturally-competent HelpLine and outreach initiatives.
• Provide access to up-to-date information about all health care coverage options and health reform related issues (in English, Spanish and Portuguese). 
• Conduct a statewide outreach campaign in collaboration with community, faith, business and governmental leaders to raise awareness of the availability of counseling services.
• Assist consumers’ enrollment in existing Massachusetts programs that help pay for group health plan and health insurance premiums.
• Track data on consumer concerns and enrollment and share it with policymakers and advocates in order to develop and advance policy solutions.
• Track data on consumer concerns and enrollment and share it with policymakers and advocates in order to develop and advance policy solutions
• Coordinate among state agencies, an extensive network of coalition allies, and other consumer organizations to ensure effective collaboration.
  

 Michigan

Office of Financial and Insurance Regulations

Amount Awarded:  $900,000

• Increase consumer’s awareness of OFIR’s services and provide expanded consumer assistance services to Michigan consumers with health insurance related issues.
• Hire additional staff to assist in implementing and orchestrating an efficient and effective expansion of current consumer assistance activities to reach underserved populations in our state and expansion of our appeals services.
• Train staff to improve staff’s knowledge of the health care reforms, use of data collection and reporting programs to meet enhanced HHS reporting requirements, and use of any new tools implemented to expand OFIR’s services to underserved populations.
• Develop and implement a plan to increase the awareness of the available services by: 
• Holding town hall meetings across the state.
• Creating PSAs to targeted populations.
• Providing the ability for Michigan consumers who speak languages other than English to converse with OFIR staff on health related issues.
• Creating and publishing brochures and informational material in English, Spanish and Arabic.
• Expand data collection to fulfill the new data collection and reporting requirements of HHS.
• Monitor and evaluate the success of the expansion of the consumer assistance services.

 Mississippi

Attorney General’s Office, Consumer Protection Division

Amount Awarded:  $266,000

• Advance the programs currently provided by MHAP and MPHCA, including outreach campaigns to educate parents on the advantages of the requirements for obtaining coverage under Medicaid and the state Children’s Health Insurance Program (CHIP).
• Increase enrollment and retention of eligible individuals in Medicaid, CHIP and private insurance programs and identify problems in the process.

 Missouri

Department of Insurance

Amount Awarded:  $671,651

• Create an independent Office of Health Insurance Ombudsman to be housed within the Division in order to deliver additional assistance to consumers.
• Assist consumers with health coverage complaints and with filing their first and second level appeals for both fully insured and self-insured health plans.
• Refer files with adverse determinations for an independent medical review.
• Assist consumers in finding and enrolling in health plans.
• Hire three benefit counselors who will:
• Answer general inquiries about health coverage options.
• Educate consumers about different types of coverage options available.
• Provide information from the web portal regarding cost.
• Provide information regarding insurance company complain indices.
• Assist individuals with completing health insurance applications and will assist with consumers with problems with premium tax credits through the Exchanges.

 Montana

Commissioner of Securities and Insurance, Office of the Montana State Auditor (CSI)

Amount Awarded:  $149,880

• Upgrade its information technology system to collect new data in increasing amounts. 
• Upgrade a recordable phone system with data system interface.
• Hire a consultant to analyze all systems for security, privacy and efficiency.
• Increase ability to handle more complaints in greater detail, by providing more staffing, training and increased focus on assisting with appeals and tracking additional inquiries and referrals. 
• Do an outside assessment of the CSI’s consumer advocacy services and their independence from regulatory functions of the agency.
• Increase education efforts to ensure that Montana consumers know where to turn with inquiries and complaints about their coverage, through community meetings, public service announcements, and new materials. 

 Nevada

Office of the Governor, Consumer Health Assistance (GovCHA)

Amount Awarded:  $240,000

• Hire new staff for quality assurance specialist to advocate for consumers lost in the system
• Expand ability to assist consumers with physical, cultural or language barriers to care by setting up a “Language Translator” line for telephonic use to increase program cultural and linguistic capability to 240 languages and dialects, translate materials and interpret for the Deaf and Hard of Hearing
• Expand outreach to additional rural and urban populations by increased collaboration with community partners
• Provide managed care, fully insured and self funded health plans/policy consumers with information and clarification of benefits and assist consumers in filing grievances, complaints, billing disputes and appeals
• Increase technical capacity to track information on services provided.
  

 New Hampshire

New Hampshire Insurance Department

Amount Awarded:  $149,880

• Provide the resources to initially fund the new Health Insurance Consumer Advocate position .
• Enter into one or more subcontracts with two third-party, non-profit organizations for consumer education and outreach services.
• Update utilization of the NAIC complaint database system, and as necessary, the Department’s phone system to prepare for increased call volume and to make other IT improvements.
• Contract with a separate vendor to provide translation services and other necessary improvements to ensure accessibility for disabled consumers.

 New Jersey

Department of Banking and Insurance

Amount Awarded:  $887,756

• Increase staffing and enhance activities for existing staff by:
• Filling two new full-time salaried positions to coordinate outreach as well as educate and advocate for consumers in the appeals process.
• Creating a student intern program to handle health insurance inquiries and complaints (telephone and walk-in) as well as assist with community outreach presentations.
• Secure training for staff on advance health insurance topics and health care reform.
• Conduct community outreach meetings throughout the state to educate consumers on their rights and responsibilities under ACA and to advise them of the advocacy functions available.
• Develop consumer guides and pamphlets dealing with various facets of the Affordable Care Act.
• Implement a multi-media health insurance campaign via print, website, radio and local television announcements.
• Cover additional health insurance-related calls to toll-free hotlines and language translation services for callers with limited English proficiency.
• Upgrade computer systems to meet the new reporting requirements.

 New Mexico

Public Regulation Commission, Division of Insurance, Managed Health Care Bureau

Amount Awarded:  $226,426

• Support the development of outreach materials and program information.
• Fund travel expenses for an ombudsman and staff.
• Provide volunteer and staff training.
• Develop IT systems.
• Provide interpreter services contract, a hotline system, and general supplies and equipment.
• Create an ombudsman position that will collaborate with certified community advocates and volunteers throughout the state to develop formal arrangements to:
• Deliver consumer services and information.
• Facilitate rulemaking and rule changes needed for the adoption of the Uniform Health Carrier External Review Model Act.
• Assist the Superintendent of Insurance with the selection of an independent review organization to be used for adverse appeals.

 New York

Department of Health

Amount Awarded:  $1,760,000

• Provide consumer assistance to at least 8,000 New Yorkers with their enrollment in coverage and/or their navigation and disputes with insurance carriers.
• Expand accessible (walk-in) consumer assistance services to key regions in the state which currently do not have this capacity.
• Build health care expertise and capacity in selected non-profit Community Based Organizations (CBO’s) in New York.
• Generate meaningful reports, using program data, about consumer health issues for review with government officials and other key stakeholders and constituencies.
• Raise consumer awareness and promote enrollment and appropriate utilization of New York’s PCIP program.
• Expand consumer assistance services to targeted vulnerable populations (e.g. immigrants, people with disabilities, people of color and people who speak languages other than English) and underserved communities.
• Enhance existing state services, such as hotlines, to ensure that walk-in assistance is available in key demographically and geographically underserved regions of the state.
  

 North Carolina

Department of Insurance, Ombudsman Services Group

Amount Awarded:  $850,000

• Build on existing services provided by the Healthcare Review Program which provides external review and consumer counseling on appeals and grievance issues to consumers.
• Develop the North Carolina Consumer Assistance Program and the new components of service that will be provided by the program by hiring additional staff to serve as consumer advocate specialists who will use a case management model to coordinate and deliver the multitude of services consumers may need as they transition to new health insurance programs
• Add staff who will use a case management model to coordinate and deliver the multitude of services consumers may need as they transition to new health insurance programs.
• Develop the North Carolina Consumer Assistance Program and the new components of service that will be provided by the program by hiring additional staff to serve as consumer advocate specialists who will use a case management model to coordinate and deliver the multitude of services consumers may need as they transition to new health insurance programs.
• Establishing a Community Advisory Board representing consumers, consumer based non-profit organizations, and other critical stakeholders who will receive data and information relating to the issues and activities of the North Carolina Consumer Assistance Program
  

 Oklahoma

Insurance Department, Health Care Ombudsman Program

Amount Awarded:  $415,414

• Connect consumers with health insurance programs and resources.
• Assist consumers with health insurance related issues through the establishment of effective outreach programs.
• Develop communication and education materials related to consumer rights and responsibilities as well as advocating on behalf of consumers.
• Assist consumers to make informed decisions when selecting a health plan.
• Help consumer resolve problems with their health insurance plans.
• Identify issues, trends and problems that may require executive, regulatory or legislative intervention.
• Develop a statewide system of healthcare ombudsman volunteers who can assist individuals with health insurance related issues.

 Oregon

Department of Consumer and Business Services Consumer Advocacy Unit

Amount Awarded:  $400,000

• Coordinate Clearinghouse for Health Insurance Information and Advocacy to assist consumers in receiving the appropriate assistance across state agencies and consumer organizations and refer consumers to the proper entity.
• Develop resource directories and educational strategies to create a details contact and resource director to assist with referrals.
• Enhance the Departments enrollment assistance services by helping consumers fill out necessary forms, particularly for consumers with disabilities, language barriers or literacy challenges.
• Expand efforts in bringing awareness of health advocacy and assistance program, including outreach materials, radio public service announcements and website updates.

 Pennsylvania

Pennsylvania Insurance Department

Amount Awarded:  $1,100,000

• Expand advocacy on behalf of health insurance consumers.
• Create an integrated, state-wide education and consumer outreach program on benefits offered by the Affordable Care Act and its implementation.
• Develop new internet web enhancements that will allow consumers to:
• Check on the status of the Pennsylvania Insurance Department’s review of their complaints and inquiries
• Submit comments and/or questions
• Check on the overall consumer complaint record for insurance companies

 Puerto Rico

Office of the Patient’s Advocate

Amount Awarded:  $396,744

• Expand the Call Center of the Office of the Patient Advocate services:
• Increase the number of calls registered by the Call Center by contracting for four new Service Representative positions.
• Attend to increased calls by contracting for four new Guidance and Information Officers positions.
• Resolve complaints by contracting seven new positions of Grievance Officers with the capacity to resolve grievances.
• Ensure the quality of service to the consumer patients by contracting a new Team Leader position to increase monitoring efficiency and effectiveness.
  

 Rhode Island

Department of Business Regulation

Amount Awarded:  $149,880

• Provide new high quality, comprehensive and sustained consumer education and outreach on health insurance reform and coverage.
• Increase coordination between the various state, federal and non-governmental agencies and programs.
• Expand current departmental consumer inquiry and complaint capabilities for the insured and uninsured.
• Provide new assistance with the health insurance enrollment and appeal process.
• Hire two full time equivalent positions to:
• Field questions, investigate complaints and resolve problems for people who need bilingual (Spanish/English) services.
• Assist consumers with insurance coverage appeals and handle data collection and reporting responsibilities.
• Develop accessible written, web-based and broadcast materials on health insurance reform and coverage, conducting related training sessions and raising awareness of expanded consumer assistance capabilities, including helping the uninsured find health insurance.

 South Carolina

Department of Insurance

Amount Awarded:  $441,000

• Partner with organizations that provide enrollment assistance to South Carolina consumers.
• Provide training on the Affordable Care Act to insurers and producers
• Enhance the assistance provided by current staff with temporary grant employees, student interns, and non-profit volunteers
• Attain student interns who will assist with handling consumer calls and inquiries and provide general directory information
• Student interns will also assist consumers in completion of the form(s) for complaints and inquiries received via telephone, which will be referred to health insurance analysts for more substantive reviews, investigations, and contact with insurers
• Expand consumer education and outreach services by developing printed literature, webinars, and other easily downloadable documents from the program’s website
• Develop training materials and train nonprofit organization and state agencies on the requirements of and consumer rights under the Affordable Care Act
• Enhance IT systems to support consumer complaint databases

 Tennessee

Department of Commerce and Insurance

Amount Awarded:  $580,000

• Dedicate two investigators to deal with health insurance issues.
• Train existing Consumer Education Specialists in the requirements of the Affordable Care Act.
• Provide outreach and education to consumers on their rights under the Affordable Care Act.
• Contract with a qualified non-profit organization to provide assistance to consumers.
• Provide a toll-free telephone line and web-based access, including suitable access for people with limited English proficiency, the hearing impaired, and those with mental health and substance abuse issues.
• Collect and report data as required by the grant.
• Partner with the TN SHIP to provide walk-in assistance for consumers and through the telephone hotline.

 Texas

Department of Insurance

Amount Awarded:  $2,792,180

• Launch a statewide media/educational program, using multilingual materials and presentations with a focus on Texas counties with the highest percentage of uninsured residents.
• Offer a dedicated toll-free line that will direct consumers to specialists for direct assistance.
• Develop robust training and resource materials for the ombudsman program staff and stakeholders.
• Create “toolkits” to help consumers and small businesses enroll in health coverage through public programs and the private insurance industry.
• Provide individual assistance with the filing of complaints, appeals, and grievances.
• Select strategic distribution points to meet consumers where they live, work, and receive healthcare.
• Report detailed data information regarding consumers’ inquiries and complaints to support enforcement efforts.

 Vermont

Department of Banking, Insurance, Securities and Health Care Administration

Amount Awarded:  $135,000

• Expand services by hiring at least one additional advocate and increasing the hours of part-time staff attorney.
• Increase its services to better respond to Vermonters needing help with health care and health insurance issues.
• Expand services to resolve problems with any benefits provided by the Affordable Care Act.

 Virgin Islands

Office of the Lieutenant Governor

Amount Awarded:  $140,000

• Hire additional staff to support the added regulatory responsibilities.
• Provide training to all staff who will be involved in delivery services relative to the Affordable Care Act.
• Upgrade the existing computer network to manage and securely store the data associated with consumer complaints and inquiries.
• Conduct an extensive public education campaign to inform residents about the options available to them as a part of the Affordable Care Act by utilizing newspaper, TV and radio advertising, direct mail, and the publication and distribution of informational brochures, pamphlets, and other materials
• Monitor progress in implementation of consumer protections by tracking the rate at which consumer complaints and inquiries are successfully resolved and by the numbers of residents who have gained access to the healthcare system through plan enrollment

 Virginia

Virginia State Corporation Commission

Amount Awarded:  $830,000

• Expand the consumer assistance services of the Virginia State Corporation Commission, Bureau of Insurance in accident and sickness insurance.
• Add demographic data collection and tracking functionality within the existing consumer services system (CS System) and objectively report data.
• Increase outreach activities to make information available to consumers regarding their rights and responsibilities under their health insurance policies or plans by expanding outreach efforts and disseminating educational materials to minority populations and to uninsured and underinsured populations.
• Provide additional levels of consumer assistance contemplated by the Affordable Care Act.

 Washington

Office of the Insurance Commissioner

Amount Awarded:  $647,860

• Create a consumer education presentation about the Affordable Care Act in English, Chinese and Spanish to be used in at least ten linguistically and culturally appropriate education events.
• Help consumers resolve health care related issues and facilitate referrals for help with the resolution of disputes.
• Develop an online Toolkit in English, Chinese and Spanish to assist with health plan appeals.
• Assist consumers with their appeals by providing support through the process.
• Enhance current data collection systems.

 West Virginia

Offices of the Insurance Commissioner

Amount Awarded:  $205,031

• Expand consumer advocacy through trained staff and development of partnerships with non-profit community and consumer organizations and other agencies.
• Train staff and partners on the federal reforms under the Affordable Care Act through statewide workshops.
• Expand staff by hiring an attorney, project liaison and clerical person to assist with increased workload.
• Obtain equipment for new staff, a dedicated toll-free consumer assistance telephone number which will handle additional incoming and outgoing lines and utilize language service to assist those consumers who may not speak English.
• Change IT to accommodate new equipment and telephone lines and changes necessary for our existing database.
• Develop and procure new consumer educational materials in written and electronic versions for the website.
• Conduct consumer outreach and education through statewide community forums, meetings, fairs and festivals and media spots.

Posted: October 19, 2010